BackgroundAmbient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and preterm birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways.ObjectivesOur goal was to examine the association between traffic-related pollution and perinatal mortality.MethodsWe used the information collected for a case–control study conducted in 14 districts in the City of São Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes.ResultsLogistic regression revealed a gradient of increasing risk of early neonatal death with higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47; 95% confidence interval, 0.67–3.19). Associations for fetal mortality were less consistent.ConclusionsThese results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality.

ObjectiveAir pollution has been investigated as a potential determinant for low birthweight. The aim of the present study was to study the effect of air pollution on birthweight. MethodsWe analyzed all deliveries by mothers living in the municipality of São Paulo, Southeastern Brazil, between 1998 and 2000. We estimated the prevalence of low birthweight according to newborn, mother, and delivery characteristics. Only births occurring in the most central districts of the city were analyzed, totaling 311.735 events. For the evaluation of the effects of air pollution, we excluded preterm and multiple deliveries. Pollutants analyzed were ozone (O 3 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), suspended particles (PM 10 ), and carbon monoxide (CO). The effect of maternal exposure to air pollution on birthweight was evaluated using linear and logistic regression. Results A total of 4.6% of newborns weighed less than 2,500 g at birth. Maternal exposure to CO, PM 10 , and NO 2 during the first trimester of pregnancy was significantly associated with decreased birthweight. ConclusionsOur results reinforce the notion that maternal exposure to air pollution during the first trimester of pregnancy may contribute to lesser weight gain in the fetus.

A poluição atmosférica é uma das maiores preocupações para a saúde pública. Entre os estudos conduzidos para testar a associação entre poluição do ar e os mais diversos desfechos em saúde, alguns utilizaram dados viários e de tráfego veicular como avaliação da exposição. O presente trabalho pretende revisar e discutir alguns dos aspectos metodológicos dos estudos que utilizaram este método, principalmente em áreas onde a fonte veicular é uma grande geradora de poluentes. Realizou-se uma busca bibliográfica com palavras-chave relacionadas à poluição atmosférica e tráfego veicular, e foram selecionados artigos publicados entre os anos de 2000 e 2009. Foram constatadas várias abordagens para avaliar a exposição, enfatizando-se o método da Densidade de Tráfego Ponderada pela Distância, que considera as vias e a distância das mesmas em relação ao local de interesse e o tráfego. Além disso, destaca-se a importância do uso de técnicas de sistemas de informação geográfica (SIG) como instrumento na construção de modelos para mensurar a exposição.

Objective: To identify spatial patterns in rates of admission for pneumonia among children and relate them to the number of fires reported in the state of Mato Grosso, Brazil. Methods:We conducted an ecological and exploratory study of data from the state of Mato Grosso for 2008 and 2009 on hospital admissions of children aged 0 to 4 years due to pneumonia and on fires in the same period. Admission rates were calculated and choropleth maps were plotted for rates and for fire outbreaks, Moran's I was calculated and the kernel estimator used to identify "hotspots." Data were analyzed using TerraView 3.3.1. Results:Fifteen thousand six hundred eighty-nine children were hospitalized (range zero to 2,315), and there were 161,785 fires (range 7 to 6,454). The average rate of admissions per 1,000 inhabitants was 2.89 (standard deviation [SD] = 5.18) and the number of fires per 1,000 inhabitants was 152.81 (SD = 199.91). Moran's I for the overall number of admissions was I = 0.02 (p = 0.26), the index for rate of admission was I = 0.02 (p = 0.21) and the index for the number of fires was I = 0.31 (p < 0.01). It proved possible to identify four municipalities with elevated rates of admissions for pneumonia. It was also possible to identify two regions with high admission densities. A clustering of fires was evident along what is known as the "arc of deforestation." Conclusions:This study identified municipalities in the state of Mato Grosso that require interventions to reduce rates of admission due to pneumonia and the number fires.J Pediatr (Rio J). 2012;88(2):177-83: Pneumonia, geographic information system, fires, biomass burning, ecological studies. ResumoObjetivo: Identificar padrões espaciais para taxas de internação por pneumonia em crianças e para focos de queimada no estado do Mato Grosso. Metodologia:Foi realizado um estudo ecológico e exploratório com dados de internação de pneumonia em criança de 0 a 4 anos e de focos de queimada para o estado do Mato Grosso relativos aos anos de 2008 e 2009. Foram criadas taxas de internação, construídos mapas temáticos para essas taxas e para focos de queimada e obtidos os índice de Moran global e estimador de Kernel para as taxas e focos de queimada. Os dados foram analisados pelo programa TerraView 3.3.1.Resultados: Foram 15.689 internações (variando de zero a 2.315) e 161.785 focos de queimadas (variando de sete a 6.454). A taxa média de internação por 1.000 habitantes foi de 2,89 [desvio padrão = 5,18] e de queimadas por 1.000 habitantes foi de 152,81 (desvio padrão = 199,91). O índice de Moran global para o número de internações foi de 0,02 (p = 0,26), para a taxa de internação foi de 0,02 (p-valor = 0,21), e de 0,31 (p-valor < 0,01) para focos de queimadas. Foi possível identificar quatro municípios com elevadas taxas de internação por pneumonia e identificar duas regiões com altas densidades de internação. Ficou evidente um adensamento de focos de queimadas no chamado arco de desmatamento. Conclusões:Este estudo permitiu identificar municípios que necessitam...

The survey results indicate that maternal exposure to air pollution in the 1st and 3rd trimesters of pregnancy for residents of São José dos Campos create considerable potential to cause insufficient weight.

OBJECTIVE: To investigate the effect of air pollution on birth weight in a medium-sized town in the State of São Paulo, Southeast Brazil. METHODS: Cross-sectional study using data from live births of mothers residing in São José dos Campos from 2005 to 2009. Data was obtained from the Department of Information and Computing of the Brazilian Unified Health System. Air pollutant data (PM10, SO2, and O3) and daily averages of their concentrations were obtained from the Environmental Sanitation & Technology Company. Statistical analysis was performed by linear and logistic regressions using the Excel and STATA v.7 software programs. RESULTS: Maternal exposure to air pollutants was not associated with low birth weight, with the exception of exposure to SO2 within the last month of pregnancy (OR=1.25; 95% CI=1.00-1.56). Maternal exposure to PM10 and SO2 during the last month of pregnancy led to lower weight at birth (0.28g and 3.15g, respectively) for each 1mg/m3 increase in the concentration of these pollutants, but without statistical significance. CONCLUSIONS: This study failed to identify a statistically significant association between the levels of air pollutants and birth weight, with the exception of exposure to SO2 within the last month of pregnancy.

A time-series ecological study was developed to estimate the role of air pollutants in the mean daily duration of hospitalization for pneumonia in children under one year old and living in São José dos Campos, SP, between January 1, 2009 and December 31, 2009. Air pollutants PM 10 , SO 2 and O 3 , and climatic variables were measured by the Environmental Company of the State of São Paulo (Cetesb). The duration of each hospitalization was obtained from the Datasus site. The values of air pollutants and climatic variables were analyzed using multiple linear regression in lags of zero to five days; the dependent variable was the mean duration of hospitalization and the independent variables were the pollutants. We obtained R 2 and alpha = 0.05 was the significance level of the model. There were 559 children under one year of age admitted during the study period; the mean hospital stay was 3.81 days (SD = 4.06). The PM 10 was associated with length of stay in concurrent days and lags four and five (P <0.001, R 2 = 0.08); a 15 μg.m-3 increase in concentration of this pollutant implies an increase of approximately one day of mean time of hospitalization for lags of 0, 4 and 5 days. It was therefore possible to identify the role of particulate matter in the duration of pneumonia hospitalizations in children.

Objective To describe the referral for colposcopy in a Hospital in Brazil and the relative frequency of patients who benefited from it, considering the correct indications for the examination and its final diagnoses. Methods A retrospective study was performed in the colposcopy service database of the Hospital Universitário de Taubaté, Taubaté, state of São Paulo, Brazil. The frequency validated in the analysis of the medical records of women referred for clinical indication or cytological alteration, attended from March 2015 to March 2017. The population selected and analyzed included 256 results that were correlated to the cytological, clinical data and the result of the colposcopy. Results Of the women referred, 45% presented out of the age of screening according to the guidelines of cervical cancer screening, 8.6% being adolescents and young adults < 25 years old, and 36.4% of the patients being ≥ 65 years old. A total of 50% of the patients had no indication of colposcopy, that is, normal cytologies, benign changes, ectopia, cervicitis, atypical squamous cells of indeterminate significance (ASC-US) and low-grade intraepithelial lesion (LSIL) without persistence and normal clinical appearance. A total of 39.84% who underwent colposcopy had high-grade lesion or cancer results, thus benefiting from the adequate referral. Conclusion Most (60.16%) of the patients referred to the colposcopy service did not benefit from the referral for results without changes, such as negative colposcopies, histologies with no cervical intraepithelial neoplasm (CIN) or only CIN 1, or were out of the age for screening. These findings therefore demonstrate a significant number of unnecessary and inadequate referrals.