Search

Background: Heat waves are becoming more intense and extreme as a consequence of global warming. Epidemiological evidence reveals the health impacts of heat waves in mortality and morbidity outcomes, however, few studies have been conducted in tropical regions, which are characterized by high population density, low income and low health resources, and susceptible to the impacts of extreme heat on health. The aim of this paper is to estimate the effects of heat waves on cardiovascular and respiratory mortality in the city of Rio de Janeiro, Brazil, according to sex, age, and heat wave intensity., Methods: We carried out a time-stratified case-crossover study stratified by sex, age (0-64 and 65 or above), and by sex for the older group. Our analyses were restricted to the hot season. We included 42,926 participants, 29,442 of whom died from cardiovascular and 13,484 from respiratory disease, between 2012 and 2017. The death data were obtained from Rio de Janeiro's Municipal Health Department. We estimated individual-level exposure using the inverse distance weighted (IDW) method, with temperature and humidity data from 13 and 12 stations, respectively. We used five definitions of heat waves, based on temperature thresholds (90th, 92.5th, 95th, 97.5th, and 99th of individual daily mean temperature in the hot season over the study period) and a duration of two or more days. Conditional logistic regression combined with distributed lag non-linear models (DLNM) were used to estimate the short-term and delayed effects of heat waves on mortality over a lag period (5 days for cardiovascular and 10 for respiratory mortality). The models were controlled for daily mean absolute humidity and public holidays., Results: The odds ratios (OR) increase as heat waves intensify, although some effect estimates are not statistically significant at 95% level when we applied the most stringent heat wave criteria. Although not statistically different, our central estimates suggest that the effects were greater for respiratory than cardiovascular mortality. Results stratified by sex and age were also not statistically different, but suggest that older people and women were more vulnerable to the effects of heat waves, although for some heat wave definitions, the OR for respiratory mortality were higher among the younger group. The results also indicate that older women are the most vulnerable to heat wave-related cardiovascular mortality., Conclusion: Our results show an increase in the risk of cardiovascular and respiratory mortality on heat wave days compared to non-heat wave ones. These effects increase with heat wave intensity, and evidence suggests that they were greater for respiratory mortality than cardiovascular mortality. Furthermore, the results also suggest that women and the elderly constitute the groups most vulnerable to heat waves., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Silveira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The Brazilian Amazon faces overlapping socio-environmental, sanitary, and climate challenges, and is a hotspot of concern due to projected increases in temperature and in the frequency of heat waves. Understanding the effects of extreme events on health is a central issue for developing climate policies focused on the population's health., Objectives: We investigated the effects of heat waves on mortality in the Brazilian Amazon, examining effect modification according to various heat wave definitions, population subgroups, and causes of death., Methods: We included all 32 Amazonian municipalities with more than 100,000 inhabitants. The study period was from 2000 to 2018. We obtained mortality data from the Information Technology Department of the Brazilian Public Healthcare System, and meteorological data were derived from the ERA5-Land reanalysis dataset. Heat waves were defined according to their intensity (90th; 92.5th; 95th; 97.5th and 99th temperature percentiles) and duration (≥2, ≥3, and ≥4 days). In each city, we used a time-stratified case-crossover study to estimate the effects of each heat wave definition on mortality, according to population subgroup and cause of death. The lagged effects of heat waves were estimated using conditional Poisson regression combined with distributed lag non-linear models. Models were adjusted for specific humidity and public holidays. Risk ratios were pooled for the Brazilian Amazon using a univariate random-effects meta-analysis., Results: The pooled relative risks (RR) for mortality from total non-external causes varied between 1.03 (95% CI: 1.01-1.06), for the less stringent heat wave definition, and 1.18 (95% CI: 1.04-1.33) for the more stringent definition. The mortality risk rose as the heat wave intensity increased, although the increase from 2 to 3, and 3-4 days was small. Although not statistically different, our results suggest a higher mortality risk for the elderly, this was also higher for women than men, and for cardiovascular causes than for non-external or respiratory ones., Conclusions: Heat waves were associated with a higher risk of mortality from non-external causes and cardiovascular diseases. Heat wave intensity played a more important role than duration in determining this risk. Suggestive evidence indicated that the elderly and women were more vulnerable to the effects of heat waves on mortality., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Background: Several epidemiological studies have reported associations between ambient air pollution and mortality. However, relatively few studies have investigated this relationship in Brazil using individual-level data., Objectives: To estimate the short-term association between exposure to particulate matter <10 μm (PM10) and ozone (O3), and cardiovascular and respiratory mortality in Rio de Janeiro, Brazil, between 2012 and 2017., Methods: We used a time-stratified case-crossover study design with individual-level mortality data. Our sample included 76,798 deaths from cardiovascular diseases and 36,071 deaths from respiratory diseases. Individual exposure to air pollutants was estimated by the inverse distance weighting method. We used data from seven monitoring stations for PM10 (24-hour mean), eight stations for O3 (8-hour max), 13 stations for air temperature (24-hour mean), and 12 humidity stations (24-hour mean). We estimated the mortality effects of PM10 and O3 over a 3-day lag using conditional logistic regression models combined with distributed lag non-linear models. The models were adjusted for daily mean temperature and daily mean absolute humidity. Effect estimates were presented as odds ratios (OR) with their 95% confidence interval (CI) associated with a 10 μg/m3 increase in each pollutant exposure., Results: No consistent associations were observed for both pollutant and mortality outcome. The cumulative OR of PM10 exposure was 1.01 (95% CI 0.99-1.02) for respiratory mortality and 1.00 (95% CI 0.99-1.01) for cardiovascular mortality. For O3 exposure, we also found no evidence of increased mortality for cardiovascular (OR 1.01, 95% CI 1.00-1.01) or respiratory diseases (OR 0.99, 95% CI 0.98-1.00). Our findings were similar across age and gender subgroups, and different model specifications., Conclusion: We found no consistent associations between the PM10 and O3 concentrations observed in our study and cardio-respiratory mortality. Future studies need to explore more refined exposure assessment methods to improve health risk estimates and the planning and evaluation of public health and environmental policies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cortes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Socioeconomic factors have exacerbated the impact of COVID-19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID-19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID-19 mortality in large urban centers in Brazil. We compiled weekly COVID-19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID-19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID-19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID-19, as supported by the observed associations in this study., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Sousa Filho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This article describes the Salvador Primary Care Longitudinal Study of Child Development (CohortDICa). The exposed group was defined by confirmation of Congenital Zika Syndrome (CZS) diagnosed through computed tomography, magnetic resonance or transfontanellar ultrasound. A random selection of the 169 exposed children led to a subgroup of 120 children who were paired with children from the Live Birth Information System, according to birthdate, residence in the same street or neighborhood, and gestational age, resulting in 115 subjects in the non-exposed group. Following recruitment and before the participants completed 42 months, three measures were applied to assess cognitive, motor, and language performance, corresponding to three home visits. Social characteristics of the families and children, and the neurocognitive development of the children will be compared across the CZS exposed group ( n = 147), the typical children with no exposure to CZS ( n = 115) and the STORCH exposed group (Syphilis, Toxoplasma gondii, Rubella, Cytomegalovirus, and Herpes simplex) ( n = 20). Primary Health Care (PHC) should include long-term care strategies for the care of children and family members, and might benefit from the research, teaching, and extension activities provided in this study. In the face of the consequences of the Zika virus epidemic, an opportunity arose to intervene in the integrated care of child development within PHC, including, on an equal basis, typical children and those with delays or disabilities in the first six years of life.

Background: There is an urgent need for more information about the climate change impact on health in order to strengthen the commitment to tackle climate change. However, few studies have quantified the health impact of climate change in Brazil and in the Latin America region. In this paper, we projected the impacts of temperature on cardiovascular (CVD) mortality according to two climate change scenarios and two regionalized climate model simulations in Brazilian cities., Methods: We estimated the temperature-CVD mortality relationship in 21 Brazilian cities, using distributed lag non-linear models in a two-stage time-series analysis. We combined the observed exposure-response functions with the daily temperature projected under two representative concentration pathways (RCP), RCP8.5 and RCP4.5, and two regionalized climate model simulations, Eta-HadGEM2-ES and Eta-MIROC5., Results: We observed a trend of reduction in mortality related to low temperatures and a trend of increase in mortality related to high temperatures, according to all the investigated models and scenarios. In most places, the increase in mortality related to high temperatures outweighed the reduction in mortality related to low temperatures, causing a net increase in the excess temperature-related mortality. These trends were steeper according to the higher emission scenario, RCP8.5, and to the Eta-HadGEM2-ES model. According to RCP8.5, our projections suggested that the temperature-related mortality fractions in 2090-99 compared to 2010-2019 would increase by 8.6% and 1.7%, under Eta-HadGEM2-ES and Eta-MIROC5, respectively. According to RCP4.5, these values would be 0.7% and -0.6%., Conclusions: For the same climate model, we observed a greater increase trend in temperature-CVD mortality according to RCP8.5, highlighting a greater health impact associated with the higher emission scenario. Our results may be useful to support public policies and strategies for mitigation of and adaptation to climate change, particularly in the health sector., (Copyright © 2021 Elsevier Inc. All rights reserved.)

COVID-19 is now identified in almost all countries in the world, with poorer regions being particularly more disadvantaged to efficiently mitigate the impacts of the pandemic. In the absence of efficient therapeutics or large-scale vaccination, control strategies are currently based on non-pharmaceutical interventions, comprising changes in population behavior and governmental interventions, among which the prohibition of mass gatherings, closure of non-essential establishments, quarantine and movement restrictions. In this work we analyzed the effects of 707 governmental interventions published up to May 22, 2020, and population adherence thereof, on the dynamics of COVID-19 cases across all 27 Brazilian states, with emphasis on state capitals and remaining inland cities. A generalized SEIR (Susceptible, Exposed, Infected and Removed) model with a time-varying transmission rate (TR), that considers transmission by asymptomatic individuals, is presented. We analyze the effect of both the extent of enforced measures across Brazilian states and population movement on the changes in the TR and effective reproduction number. The social mobility reduction index, a measure of population movement, together with the stringency index, adapted to incorporate the degree of restrictions imposed by governmental regulations, were used in conjunction to quantify and compare the effects of varying degrees of policy strictness across Brazilian states. Our results show that population adherence to social distance recommendations plays an important role for the effectiveness of interventions and represents a major challenge to the control of COVID-19 in low- and middle-income countries., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Many factors related to susceptibility or vulnerability to temperature effects on mortality have been proposed in the literature. However, there is limited evidence of effect modification by some individual-level factors such as occupation, colour/race, education level and community-level factors. We investigated the effect modification of the temperature-cardiovascular mortality relationship by individual-level and neighbourhood-level factors in the city of Rio de Janeiro, Brazil., Methods: We used a case-crossover study to estimate the total effect of temperature on cardiovascular mortality in Rio de Janeiro between 2001 and 2018, and the effect modification by individual-level and neighbourhood-level factors. Individual-level factors included sex, age, colour/race, education, and place of death. Neighbourhood-level characteristics included social development index (SDI), income, electricity consumption and demographic change. We used conditional Poisson regression models combined with distributed lag non-linear models, adjusted for humidity and public holidays., Results: Our results suggest a higher vulnerability to high temperatures among the elderly, women, non-hospitalised deaths, and people with a lower education level. Vulnerability to low temperatures was higher among the elderly, men, non-white people, and for primary education level. As for neighbourhood-level factors, we identified greater vulnerability to low and high temperatures in places with lower SDI, lower income, lower consumption of electricity, and higher demographic growth., Conclusion: The effects of temperature on cardiovascular disease mortality in Rio de Janeiro vary according to individual-level and neighbourhood-level factors. These findings are valuable to inform policymakers about the most vulnerable groups and places, in order to develop more effective and equitable public policies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases., Methods: This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients., Results: The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator., Conclusion: Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.

The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.

Objective: To explore the relationship between availability of different types of retail food stores and consumption of fruit and leafy vegetables., Study Design: This study is a cross-sectional study., Methods: Data were derived from 2032 adults living in the city of Rio de Janeiro, Brazil, participating in the longitudinal Pro-Saude Study. Exposure to street markets, fruit and vegetable stores, groceries and markets, unhealthy food outlets, restaurants, and supermarkets within 1600 m buffers was obtained by georeferencing residential addresses. Consumption of fruit and leafy vegetables was assessed via two single questions, categorized as 'yes' (≥4 days/week) and 'no' (<3 days/week). Multiple logistic regression models were used to assess relationships of interest adjusted for surrounding average monthly income, sex, age, education, and family income per capita., Results: Except for supermarkets, the presence of a greater number of retail food stores - irrespective of the type - was associated with higher odds of consumption of fruit and leafy vegetables than with areas with a lower number (e.g. odds ratio = 1.47; 95% confidence interval = 1.13-1.91)., Conclusions: The greater availability of several types of retail food stores close to participants' residences was associated with higher consumption of fruit and leafy vegetables in Rio de Janeiro., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

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., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: the aim of this study is to map thermal stress risks for human health at the São Francisco River Basin (SFRB) in the Semiarid region, for climatic scenarios RCP 4.5 and 8.5., Methods: The heat stress conditions were defined by the Wet Bulb Globe Temperature (WBGT) indicator and by the average number of annual days in which the WBGT values exceeded the 90th percentile of the reference period. The WBGT was estimated for the climate scenarios RCP 4.5 (intermediate) and 8.5 (pessimistic) for the period 2011-2090 comparing to the period of reference (1961-2005)., Results: The projections show that for the pessimistic scenario practically all municipalities of the SFRB region can reach values of WBGT that indicate a high risk for heat stress in the period 2071-2099. For this same scenario and period, the municipalities of the Lower and Under-average regions may present values of WBGT above the 90th percentile of the reference period in more than 90% of the days/year., Conclusions: These results show that, if the emission of greenhouse gases continues in the present proportions, some municipalities of the SFRB region may present a high risk for heat stress affecting the work capacity and the practice of physical exercises.

Positive influences of natural and built environment characteristics on human physical activity have been observed mainly in high-income countries, but mixed results exist. We explored these relationships in Rio de Janeiro, Brazil, where exuberant nature coexists with high levels of social inequality and urban violence. Data originated from questionnaires self-administered by 1731 civil servants at university campuses who participated in 4 waves (1999, 2001, 2007, 2012) of a longitudinal study, and had their residential addresses geocoded. In multinomial regression models, adjusted for individual sociodemographic characteristics, mutually adjusted associations were estimated between 13-year trajectories of non-work physical activity and 8 contextual variables: distances from waterfronts, cycle paths, outdoor gym equipment, and squares; 2 indicators of exposure to greenness (a vegetation index - NDVI - derived from satellite images, and trees close to home); an indicator of walkability (street density), and neighborhood average income. Compared to participants living in the upper quartile of distance to waterfronts, those living in its lowest quartile had 2.6-fold higher odds (aOR: 2.62, 95% CI: 1.37-5.01) of reporting non-work PA in all 4 study waves. Similar results were observed in relation to distance to cycle paths; no independent associations were observed with other natural and built environment variables., (Copyright © 2018 Elsevier Ltd. All rights reserved.)