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Environmental and Occupational Health in Brazil

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (30 December 2022) | Viewed by 46682

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A printed edition of this Special Issue is available here.

Special Issue Editors

Programa de Pós-Graduação em Ciências Ambientais e Conservação, Universidade Federal do Rio de Janeiro, Rio de Janeiro 27930-560, RJ, Brazil
Interests: maternal and children’s health; child growth and nutrition; neurodevelopment; maternal and child exposure to environmental pollutants
Department of Nutrition, University of Brasília, Brasília 70919-970, DF, Brazil
Interests: public health; environmental sciences; toxicology; pharmacology
Environmental and Occupacional Health and Surveillance on Public Health Emergencies, Ministério da Saúde do Brasil, CEP 70723-040, Brazil
Interests: maternal and children’s health; environmental and occupational health; health surveillance; and Sustainable Development Goals (SDG)

Special Issue Information

Dear Colleagues,

Brazil, the largest country in Latin America, is a multicultural country with abundant biodiversity, forests, and water sources. The rapid urbanization and industrialization that the country has experienced in recent decades have brought with them considerable social and economic progress. However, countless environmental and occupational risks that follow unregulated development still threaten the health of exposed children and adults from urban and rural areas. Despite a complex scenario of exposure to multiple contaminants, studies of the impacts on human health and well-being are sorely needed. Thus, building up comprehensive evidence on environmental and occupational health in Brazil is crucial to improve practices and policies toward stronger social development.

This Special Edition addresses cutting-edge epidemiological, clinical, and experimental studies, and literature reviews on all aspects of environmental and occupational health in Brazil. Studies with children, adults, and vulnerable populations related to toxicology, epidemiology, and public policies are especially welcomed. Manuscripts may include but are not limited to the adverse health effects of physical, chemical, and biological risks, exposure to air, water, soil and food pollution, metals and pesticides, organic solvents, dust, and climate change.

Prof. Dr. Rejane C. Marques
Prof. Dr. José Dórea
Dr. Rafael Junqueira Buralli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • environmental epidemiology
  • environmental health
  • occupational exposure
  • exposure assessment
  • climate change and health
  • environmental toxicology
  • biomonitoring
  • risk assessment
  • environmental policy
  • environmental health indicators
  • food and health
  • air pollution
  • heavy metals
  • pesticides
  • endocrine disruptors
  • water, sanitation, and hygiene
  • Sustainable Development Goals

Published Papers (20 papers)

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Research

23 pages, 5512 KiB  
Article
A Multi-Pollutant and Meteorological Analysis of Cardiorespiratory Mortality among the Elderly in São Paulo, Brazil—An Artificial Neural Networks Approach
by Luciana Leirião, Michelle de Oliveira, Tiago Martins and Simone Miraglia
Int. J. Environ. Res. Public Health 2023, 20(8), 5458; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20085458 - 11 Apr 2023
Viewed by 1514
Abstract
Traditionally, studies that associate air pollution with health effects relate individual pollutants to outcomes such as mortality or hospital admissions. However, models capable of analyzing the effects resulting from the atmosphere mixture are demanded. In this study, multilayer perceptron neural networks were evaluated [...] Read more.
Traditionally, studies that associate air pollution with health effects relate individual pollutants to outcomes such as mortality or hospital admissions. However, models capable of analyzing the effects resulting from the atmosphere mixture are demanded. In this study, multilayer perceptron neural networks were evaluated to associate PM10, NO2, and SO2 concentrations, temperature, wind speed, and relative air humidity with cardiorespiratory mortality among the elderly in São Paulo, Brazil. Daily data from 2007 to 2019 were considered and different numbers of neurons on the hidden layer, algorithms, and a combination of activation functions were tested. The best-fitted artificial neural network (ANN) resulted in a MAPE equal to 13.46%. When individual season data were analyzed, the MAPE decreased to 11%. The most influential variables in cardiorespiratory mortality among the elderly were PM10 and NO2 concentrations. The relative humidity variable is more important during the dry season, and temperature is more important during the rainy season. The models were not subjected to the multicollinearity issue as with classical regression models. The use of ANNs to relate air quality to health outcomes is still very incipient, and this work highlights that it is a powerful tool that should be further explored. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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13 pages, 1050 KiB  
Article
Mercury Exposure in Women of Reproductive Age in Rondônia State, Amazon Region, Brazil
by Thayssa C. S. Bello, Rafael J. Buralli, Mônica P. L. Cunha, José G. Dórea, Fredi A. Diaz-Quijano, Jean R. D. Guimarães and Rejane C. Marques
Int. J. Environ. Res. Public Health 2023, 20(6), 5225; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20065225 - 22 Mar 2023
Cited by 3 | Viewed by 1689
Abstract
Environmental contamination by mercury (Hg) is a problem of global scale that affects human health. This study’s aim was to evaluate Hg exposure among women of reproductive age residing in the Madeira River basin, in the State of Rondônia, Brazilian Amazon. This longitudinal [...] Read more.
Environmental contamination by mercury (Hg) is a problem of global scale that affects human health. This study’s aim was to evaluate Hg exposure among women of reproductive age residing in the Madeira River basin, in the State of Rondônia, Brazilian Amazon. This longitudinal cohort study used linear regression models to assess the effects on Hg levels of breastfeeding duration at 6 months, and of breastfeeding duration and number of new children at 2-year and 5-year. Breastfeeding duration was significantly associated with maternal Hg levels in all regression models (6 months, 2 years and 5 years) and no significant association was observed between the number of children and the change in maternal Hg levels in the 2-year and 5-year models. This longitudinal cohort study evaluated Hg levels and contributing factors among pregnant women from different communities (riverine, rural, mining and urban) in Rondônia, Amazon Region, for 5 years. A well-coordinated and designed national biomonitoring program is urgently needed to better understand the current situation of Hg levels in Brazil and the Amazon. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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21 pages, 3397 KiB  
Article
Influence of Environmental Exposure to Steel Waste on Endocrine Dysregulation and PER3 Gene Polymorphisms
by Gilvania Barreto Feitosa Coutinho, Maria de Fátima Ramos Moreira, Frida Marina Fischer, Maria Carolina Reis dos Santos, Lucas Ferreira Feitosa, Sayonara Vieira de Azevedo, Renato Marçullo Borges, Michelle Nascimento-Sales, Marcelo Augusto Christoffolete, Marden Samir Santa-Marinha, Daniel Valente and Liliane Reis Teixeira
Int. J. Environ. Res. Public Health 2023, 20(6), 4760; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20064760 - 08 Mar 2023
Viewed by 1152
Abstract
Objective: To evaluate the association between environmental exposure to the following chemical substances: cadmium (Cd), lead (Pb), nickel (Ni), manganese (Mn), benzene (BZN), and toluene (TLN), and Period Circadian Regulator 3 (PER3) gene variable number of tandem repeats (VNTR) polymorphisms, according [...] Read more.
Objective: To evaluate the association between environmental exposure to the following chemical substances: cadmium (Cd), lead (Pb), nickel (Ni), manganese (Mn), benzene (BZN), and toluene (TLN), and Period Circadian Regulator 3 (PER3) gene variable number of tandem repeats (VNTR) polymorphisms, according to chronotype in a population living in a steel residue-contaminated area. Methods: This assessment comprises a study conducted from 2017 to 2019 with 159 participants who completed health, work, and Pittsburgh sleep scale questionnaires. Cd, Pb, Ni, Mn, BZN, and TLN concentrations in blood and urine were determined by Graphite Furnace Atomic Absorption Spectrometry (GFAAS) and Headspace Gas Chromatography (GC), and genotyping was carried out using Polymerase Chain Reaction (PCR). Results: A total of 47% of the participants were afternoon chronotype, 42% were indifferent, and 11% were morning chronotype. Insomnia and excessive sleepiness were associated with the indifferent chronotype, while higher urinary manganese levels were associated with the morning chronotype (Kruskal–Wallis chi-square = 9.16; p < 0.01). In turn, the evening chronotype was associated with poorer sleep quality, higher lead levels in blood, and BZN and TLN levels in urine (χ2 = 11.20; p < 0.01) in non-occupationally exposed individuals (χ2 = 6.98; p < 0.01) as well as the highest BZN (χ2 = 9.66; p < 0.01) and TLN (χ2 = 5.71; p < 0.01) levels detected in residents from the influence zone 2 (far from the slag). Conclusion: Mn, Pb, benzene, and toluene contaminants may have influenced the different chronotypes found in the steel residue-exposed population. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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16 pages, 787 KiB  
Article
Determinants of Exposure to Potentially Toxic Metals in Pregnant Women of the DSAN-12M Cohort in the Recôncavo Baiano, Brazil
by Homègnon A. Ferréol Bah, Victor O. Martinez, Nathália R. dos Santos, Erival A. Gomes Junior, Daisy O. Costa, Elis Macêdo Pires, João V. Araújo Santana, Filipe da Silva Cerqueira and José A. Menezes-Filho
Int. J. Environ. Res. Public Health 2023, 20(4), 2949; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20042949 - 08 Feb 2023
Cited by 3 | Viewed by 1331
Abstract
Exposure to potentially toxic metals (PTM) threatens maternal and child health. We investigated the determinants of exposure to lead (Pb), cadmium (Cd), arsenic (As), and manganese (Mn) in 163 pregnant women from the Recôncavo Baiano, Brazil, enrolled in the DSAN-12M cohort. We measured [...] Read more.
Exposure to potentially toxic metals (PTM) threatens maternal and child health. We investigated the determinants of exposure to lead (Pb), cadmium (Cd), arsenic (As), and manganese (Mn) in 163 pregnant women from the Recôncavo Baiano, Brazil, enrolled in the DSAN-12M cohort. We measured these metals in biological samples (blood, toenails, and hair) and the Pb dust loading rates (RtPb) at their homes by graphite furnace atomic absorption spectrophotometry (GFAAS). Questionnaires were applied to collect sociodemographic and general habits data. Only 2.91% (n = 4) of the pregnant women had As levels above the detection limit. Few participants had levels above the recommended reference values for blood Pb (5.1; 95% CI: 2.1–10.1%), and Mn in hair or toenails (4.3; 95% CI: 2.3–10.1%). On the other hand, 61.1 (95% CI: 52.4–69.3%) had elevated blood Cd levels. After binary logistic regression, low socioeconomic status, domestic waste burning, being a passive smoker, multiparity, and renovating the house significantly increased the chances of having high levels of Mn, Pb, and Cd. We detected a worrying situation related to exposure to Cd, showing the urgency of implementing human biomonitoring in the general population, especially in situations of social vulnerability. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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17 pages, 410 KiB  
Article
Acute Pesticide Poisoning in Tobacco Farming, According to Different Criteria
by Neice Muller Xavier Faria, Rodrigo Dalke Meucci, Nadia Spada Fiori, Maria Laura Vidal Carret, Carlos Augusto Mello-da-Silva and Anaclaudia Gastal Fassa
Int. J. Environ. Res. Public Health 2023, 20(4), 2818; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20042818 - 05 Feb 2023
Cited by 3 | Viewed by 1443
Abstract
Background: Brazil is one of the world’s largest pesticide consumers, but information on pesticide poisoning among workers is scarce. Objective: To evaluate acute pesticide poisoning among tobacco growers, according to different criteria. Methods: This was a two-step cross-sectional study with 492 pesticide applicators. [...] Read more.
Background: Brazil is one of the world’s largest pesticide consumers, but information on pesticide poisoning among workers is scarce. Objective: To evaluate acute pesticide poisoning among tobacco growers, according to different criteria. Methods: This was a two-step cross-sectional study with 492 pesticide applicators. It used a 25 question pesticide-related symptoms (PRS) questionnaire and medical diagnosis for comparison with toxicological assessment. Associations were evaluated using Poisson regression. Results: 10.6% reported two or more PRS, while 8.1% reported three or more. Furthermore, 12.2% received a medical diagnosis of poisoning. According to toxicologists, possible cases accounted for 14.2% and probable cases for 4.3%. PRS increased during the period of greater exposure. Those exposed to dithiocarbamates, sulfentrazone, pyrethroids, fipronil and iprodione exhibited more PRS. The number of exposure types, multi-chemical exposure, clothes wet with pesticides and spillage on the body/clothes were associated with acute poisonings. All criteria showed sensitivity greater than 79% for probable cases but only greater than 70% for medical diagnosis when compared to possible cases, presenting substantial Kappa agreement. Conclusion: The prevalence of acute pesticide poisoning is much higher than officially recorded. Trained physicians can screen for pesticide poisoning. It is necessary to improve workers’ education to reduce pesticide use and exposure to them. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
11 pages, 693 KiB  
Article
Vocational Rehabilitation and Length of Stay at Work after Work-Related Musculoskeletal Disorders: A Longitudinal Study in Brazil
by Cristiano Barreto de Miranda, João Silvestre Silva-Junior, Klauss Kleydmann Sabino Garcia, Flávia Nogueira e Ferreira de Sousa and Frida Marina Fischer
Int. J. Environ. Res. Public Health 2023, 20(3), 2334; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20032334 - 28 Jan 2023
Viewed by 1351
Abstract
Vocational rehabilitation is an intervention to enhance the return to work and improve quality of life. The aim of this study was to evaluate sociodemographic and occupational factors associated with the length of stay at work among workers with work-related musculoskeletal disorders (WRMDs) [...] Read more.
Vocational rehabilitation is an intervention to enhance the return to work and improve quality of life. The aim of this study was to evaluate sociodemographic and occupational factors associated with the length of stay at work among workers with work-related musculoskeletal disorders (WRMDs) who had undergone rehabilitation through the Brazilian public social security system. This was a longitudinal study among 680 workers with histories of disability due to WRMDs who returned to the formal job market after vocational rehabilitation between 2014 and 2018. Survival analysis was performed to identify the factors influencing permanence in work. Job dismissal occurred for 29.26% of the workers. The average duration of employment after returning to the formal job position was 56 months. The following factors were associated with shorter length of employment: living in the southeastern region (HR: 2.78; 95% CI 1.12–6.91) or southern region (HR: 2.68; 95% CI 1.04–6.90) of Brazil; working in transportation, storage or postal services (HR: 2.57; 95% CI 1.07–6.17); or working in financial activities, insurance or related services (HR: 2.70; 95% CI 1.05–6.89). These findings may contribute to the discussion about prevention of disability and interventions to ensure health care for workers with WRMD disabilities who undergo rehabilitation. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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16 pages, 649 KiB  
Article
Persistent Organic Pollutant Levels in Maternal and Cord Blood Plasma and Breast Milk: Results from the Rio Birth Cohort Pilot Study of Environmental Exposure and Childhood Development (PIPA Study)
by Aline Souza Espindola Santos, Josino Costa Moreira, Ana Cristina Simoes Rosa, Volney Magalhães Câmara, Antonio Azeredo, Carmen Ildes Rodrigues Froes Asmus and Armando Meyer
Int. J. Environ. Res. Public Health 2023, 20(1), 778; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20010778 - 31 Dec 2022
Cited by 3 | Viewed by 1911
Abstract
Levels of polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP) were evaluated in the breast milk and maternal and umbilical cord blood of pregnant women and their newborns in Rio de Janeiro, Brazil. The concentration of 11 PCB and 17 OCP were measured in [...] Read more.
Levels of polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP) were evaluated in the breast milk and maternal and umbilical cord blood of pregnant women and their newborns in Rio de Janeiro, Brazil. The concentration of 11 PCB and 17 OCP were measured in 135 samples of maternal, and 116 samples of cord blood plasma, as well as 40, 47, and 45 samples of breast milk at 1st, 3rd, and 6th months after birth, respectively, using gas chromatography-mass spectrometry (GC-MS-MS). Women were asked to answer an enrollment questionnaire with reproductive, lifestyle, residential and sociodemographic questions. The most commonly detected OCPs and PCBs in the maternal and cord blood were 4,4′-DDE; β-HCH; ɣ-HCH; and PCB 28. 4,4′-DDE was also the most commonly detected OCP in breast milk samples. Although not statistically significant, ∑DDT levels were higher among women with pregestational BMI ≥ 30, and who were non-white and older (age > 40). Newborns with an Apgar score ≤ 8 at minute 5 of life showed significantly higher levels of ∑DDT in the cord blood. Persistent OCPs and PCBs were still detected in maternal and umbilical cord blood and breast milk, even after decades of their banishment in Brazil. They may pose a risk to maternal, fetal and children’s health. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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18 pages, 1205 KiB  
Article
Exposure to Inorganic Arsenic in Rice in Brazil: A Human Health Risk Assessment
by Michele C. Toledo, Janice S. Lee, Bruno L. Batista, Kelly P. K. Olympio and Adelaide C. Nardocci
Int. J. Environ. Res. Public Health 2022, 19(24), 16460; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192416460 - 08 Dec 2022
Cited by 7 | Viewed by 1761
Abstract
In certain populations, rice is the main source of exposure to inorganic arsenic (iAs), which is associated with cancer and non-cancer effects. Although rice is a staple food in Brazil, there have been few studies about the health risks for the Brazilian population. [...] Read more.
In certain populations, rice is the main source of exposure to inorganic arsenic (iAs), which is associated with cancer and non-cancer effects. Although rice is a staple food in Brazil, there have been few studies about the health risks for the Brazilian population. The objective of this study was to assess the risks of exposure to iAs from white rice and brown rice in Brazil, in terms of the carcinogenic and non-carcinogenic effects, and to propose measures to mitigate those risks. The incremental lifetime cancer risk (ILCR) and hazard quotient (HQ) were calculated in a probabilistic framework. The mean ILCR was 1.5 × 10−4 for white rice and 6.0 × 10−6 for brown rice. The HQ for white and brown rice was under 1. The ILCR for white and brown rice was high, even though the iAs concentration in rice is below the maximum contaminant level. The risk for brown rice consumption was lower, which was not expected. Various mitigation measures discussed in this report are estimated to reduce the risk from rice consumption by 5–67%. With the support of public policies, measures to reduce these risks for the Brazilian population would have a positive impact on public health. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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13 pages, 1176 KiB  
Article
A Low-Cost Method Shows Potentially Toxic Element Levels in Dust Correlated with Elevated Blood Levels of These Chemicals in Children Exposed to an Informal Home-Based Production Environment
by Fairah Barrozo, Gilmar Alves de Almeida, Maciel Santos Luz and Kelly Polido Kaneshiro Olympio
Int. J. Environ. Res. Public Health 2022, 19(23), 16236; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192316236 - 04 Dec 2022
Cited by 2 | Viewed by 1166
Abstract
Dust is recognized as a route of exposure to environmental pollutants. The city of Limeira, Sao Paulo state, Brazil, is a production center for jewelry and fashion jewelry, where part of this jewelry production is home-based, informal, and outsourced. The aim of this [...] Read more.
Dust is recognized as a route of exposure to environmental pollutants. The city of Limeira, Sao Paulo state, Brazil, is a production center for jewelry and fashion jewelry, where part of this jewelry production is home-based, informal, and outsourced. The aim of this study was to evaluate exposure to Potentially Toxic Elements (PTE: Cr, Sn, Mn, Sb, Ni, Cu, Zn, Cd, Pb, and As) in dust among children from households of informal workers using electrostatic dust cloths (EDC). Dust samples were collected in 21 exposed and 23 control families using EDC from surfaces where dust deposits had accumulated for approximately 14 days. In exposed families, dust samples were also collected from welders’ workstations. PTE concentrations were then determined using inductively coupled mass spectrometry (ICP-MS). The results raised concerns in relation to Cr, As, and Cd exposure among children within the informal home-based production environment. Blood PTE concentrations in children showed a moderate correlation with levels of Cr (Rho 0.40), Zn (Rho −0.43), and As (Rho 0.40), and a strong correlation with Cd (Rho 0.80) (p < 0.05), detected in dust. In conclusion, analyzing dust collected using EDC proved a potentially low-cost tool for determining PTE in dust. In addition, the results confirmed that informal home-based work poses a risk for children residing in these households. Public policies are needed to assist these families and promote better conditions of occupational health and safety for the whole family. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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14 pages, 409 KiB  
Article
Agrochemical Residues in Fish and Bivalves from Sepetiba Bay and Parnaiba River Delta, Brazil
by Joyce Aparecida Tavares Miranda, Fabíola Helena S. Fogaça, Sara C. Cunha, Mariana Batha Alonso, João Paulo M. Torres and José Oliveira Fernandes
Int. J. Environ. Res. Public Health 2022, 19(23), 15790; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192315790 - 27 Nov 2022
Cited by 3 | Viewed by 1476
Abstract
Accumulation of pesticides has a harmful impact on the environment and human health. The main goal of this work was to develop a method to determine and quantify the residues of thirteen pesticides in edible fish and bivalves such as parati (Mugil [...] Read more.
Accumulation of pesticides has a harmful impact on the environment and human health. The main goal of this work was to develop a method to determine and quantify the residues of thirteen pesticides in edible fish and bivalves such as parati (Mugil curema), seabass (Centropomus ssp.), mullet (Mugil brasiliensis), clams (Anomalocardia brasiliana) and mussel (Mytilus galloprovincialis) collected from Sepetiba Bay and Parnaiba River Delta (Brazil) between 2019 and 2020. Matrix solid-phase dispersion (MSPD) was used for extraction and quantification through gas chromatography coupled to tandem mass spectrometry (GC-MS/MS). The method was validated (linearity, accuracy and precision) for fatty fish (Salmo salar), lean fish (Mugil curema) and bivalves (Mytilus edulis). The survey found linear correlation coefficients (r) equal to or greater than 0.9 for almost all analytes. The relative standard deviations (RSD) of five replicates were less than 20% for almost all analytes at different concentrations in lean fish, fatty fish and bivalves. Most analytes showed satisfactory accuracy. Alachlor herbicide was found in samples of seabass, mussels, clams and parati with levels ranging between 0.55 to 420.39 μg kg−1 dw. Ethion was found in parati (maximum 211.22 μg kg−1 dw), mussels (15.1 μg kg−1 dw) and clams (maximum 44.50 μg kg−1 dw). Alachlor was found in clams (maximum 93.1 μg kg−1 dw), and bifenthrin was found in parati (maximum 43.4 μg kg−1 dw) and clams (maximum 42.21 μg kg−1 dw). The validated method was satisfactory for the determination of eleven pesticides in the fatty fish matrix, and thirteen pesticides in the samples of lean fish and bivalves. The presence of alachlor, ethion and bifenthrin stands out. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
19 pages, 3491 KiB  
Article
Potential Transformation of Contaminated Areas into Public Parks: Evidence from São Paulo, Brazil
by Camila Vitorino dos Santos and Helena Ribeiro
Int. J. Environ. Res. Public Health 2022, 19(19), 11933; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191911933 - 21 Sep 2022
Viewed by 1258
Abstract
Waste-contaminated areas have been reused and requalified environmentally across the globe, aiming to reintegrate them into urban dynamics with new functions such as public parks. This practice has attracted the attention of public health and environmental control agencies due to the scarcity of [...] Read more.
Waste-contaminated areas have been reused and requalified environmentally across the globe, aiming to reintegrate them into urban dynamics with new functions such as public parks. This practice has attracted the attention of public health and environmental control agencies due to the scarcity of free areas and vacant spaces for creation of green areas, and d the need for more sustainable planning guidelines in large cities. The present work aimed to study processes of requalification of waste-contaminated areas for transformation in parks, using as study two cases located in the city of São Paulo, Brazil. Method: Documentary research in environmental agencies, literature review and field visit. Results: In the two cases the process of requalification was unequal, with emphasis on three aspects: the actors involved in the case, the role of civil society and the action of the Public Prosecutor’s Office of the State of São Paulo. Thus, it becomes evident that successful cases of waste-contaminated areas in the city of São Paulo are linked to the direct support of these aspects complemented with the private sector. Furthermore, a consensus is necessary among the public authorities regarding the laws of contaminated areas versus environmental damage full repair in the process of requalification. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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12 pages, 1267 KiB  
Article
Acute Kidney Failure among Brazilian Agricultural Workers: A Death-Certificate Case-Control Study
by Armando Meyer, Aline Souza Espindola Santos, Carmen Ildes Rodrigues Froes Asmus, Volney Magalhaes Camara, Antônio José Leal Costa, Dale P. Sandler and Christine Gibson Parks
Int. J. Environ. Res. Public Health 2022, 19(11), 6519; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116519 - 27 May 2022
Viewed by 1523
Abstract
Recent evidence suggests that pesticides may play a role in chronic kidney disease. However, little is known about associations with acute kidney failure (AKF). We investigated trends in AKF and pesticide expenditures and associations with agricultural work in two Brazilian regions with intense [...] Read more.
Recent evidence suggests that pesticides may play a role in chronic kidney disease. However, little is known about associations with acute kidney failure (AKF). We investigated trends in AKF and pesticide expenditures and associations with agricultural work in two Brazilian regions with intense use of pesticides, in the south and midwest. Using death certificate data, we investigated trends in AKF mortality (1980–2014). We used joinpoint regression to calculate annual percent changes in AKF mortality rates by urban/rural status and, in rural municipalities, by tertiles of per capita pesticide expenditures. We then compared AKF mortality in farmers and population controls from 2006 to 2014 using logistic regression to estimate odds ratios and 95% confidence intervals adjusted by age, sex, region, education, and race. AKF mortality increased in both regions regardless of urban/rural status; trends were steeper from the mid-1990s to 2000s, and in rural municipalities, they were higher by tertiles of pesticide expenditures. Agricultural workers were more likely to die from AKF than from other causes, especially at younger ages, among females, and in the southern municipalities. We observed increasing AKF mortality in rural areas with greater pesticide expenditures and an association of AKF mortality with agricultural work, especially among younger workers. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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20 pages, 471 KiB  
Article
Neurological Impacts of Chronic Methylmercury Exposure in Munduruku Indigenous Adults: Somatosensory, Motor, and Cognitive Abnormalities
by Rogério Adas Ayres de Oliveira, Bruna Duarte Pinto, Bruno Hojo Rebouças, Daniel Ciampi de Andrade, Ana Claudia Santiago de Vasconcellos and Paulo Cesar Basta
Int. J. Environ. Res. Public Health 2021, 18(19), 10270; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910270 - 29 Sep 2021
Cited by 12 | Viewed by 2612
Abstract
There has been increasing evidence about mercury (Hg) contamination in traditional populations from the Amazon Basin due to illegal gold mining. The most concerning health impact is neurotoxicity caused by Hg in its organic form: methylmercury (MeHg). However, the severity and extent of [...] Read more.
There has been increasing evidence about mercury (Hg) contamination in traditional populations from the Amazon Basin due to illegal gold mining. The most concerning health impact is neurotoxicity caused by Hg in its organic form: methylmercury (MeHg). However, the severity and extent of the neurotoxic effects resulting from chronic environmental exposure to MeHg are still unclear. We conducted a clinical-epidemiological study to evaluate the neurological impacts of chronic MeHg exposure in Munduruku indigenous people, focusing on somatosensory, motor, and cognitive abnormalities. All participants were subjected to a systemized neurological exam protocol, including Brief Cognitive Screening Battery (BCSB), verbal fluency test, and Stick Design Test. After the examination, hair samples were collected to determine MeHg levels. Data collection took place between 29 October and 9 November 2019, in three villages (Sawré Muybu, Poxo Muybu, and Sawré Aboy) from Sawré Muybu Indigenous Land, Southwest of Pará state. One hundred and ten individuals >12 years old were included, 58 of which were men (52.7%), with an average age of 27.6 years (range from 12 to 72). Participants’ median MeHg level was 7.4 µg/g (average: 8.7; S.D: 4.5; range: 2.0–22.8). In Sawré Aboy village, the median MeHg level was higher (12.5 µg/g) than in the others, showing a significant statistical exposure gradient (Kruskal–Wallis test with p-value < 0.001). Cerebellar ataxia was observed in two participants with MeHg levels of 11.68 and 15.68 µg/g. Individuals with MeHg exposure level ≥10 µg/g presented around two-fold higher chances of cognitive deficits (RP: 2.2; CI 95%: 1.13–4.26) in BCSB, and in the verbal fluency test (RP: 2.0; CI 95%: 1.18–3.35). Furthermore, adolescents of 12 to 19 years presented three-fold higher chances of verbal development deficits, according to the fluency test (RP: 3.2; CI 95%: 1.06–9.42), than individuals of 20 to 24 years. The worsened motor and cognitive functions are suggestive of neurotoxicity due to chronic MeHg exposure. In conclusion, we believe monitoring and follow-up measures are necessary for chronic mercury exposed vulnerable people, and a basic care protocol should be established for contaminated people in the Brazilian Unified Health System. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
23 pages, 973 KiB  
Article
An Assessment of Health Outcomes and Methylmercury Exposure in Munduruku Indigenous Women of Childbearing Age and Their Children under 2 Years Old
by Joeseph William Kempton, André Reynaldo Santos Périssé, Cristina Barroso Hofer, Ana Claudia Santiago de Vasconcellos, Paulo Victor de Sousa Viana, Marcelo de Oliveira Lima, Iracina Maura de Jesus, Sandra de Souza Hacon and Paulo Cesar Basta
Int. J. Environ. Res. Public Health 2021, 18(19), 10091; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910091 - 25 Sep 2021
Cited by 8 | Viewed by 3424
Abstract
In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from [...] Read more.
In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12–49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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32 pages, 1892 KiB  
Article
Mercury Exposure in Munduruku Indigenous Communities from Brazilian Amazon: Methodological Background and an Overview of the Principal Results
by Paulo Cesar Basta, Paulo Victor de Sousa Viana, Ana Claudia Santiago de Vasconcellos, André Reynaldo Santos Périssé, Cristina Barroso Hofer, Natalia Santana Paiva, Joseph William Kempton, Daniel Ciampi de Andrade, Rogério Adas Ayres de Oliveira, Rafaela Waddington Achatz, Jamila Alessandra Perini, Heloísa do Nascimento de Moura Meneses, Gustavo Hallwass, Marcelo de Oliveira Lima, Iracina Maura de Jesus, Cleidiane Carvalho Ribeiro dos Santos and Sandra de Souza Hacon
Int. J. Environ. Res. Public Health 2021, 18(17), 9222; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179222 - 01 Sep 2021
Cited by 31 | Viewed by 6109
Abstract
The Amazonian indigenous peoples depend on natural resources to live, but human activities’ growing impacts threaten their health and livelihoods. Our objectives were to present the principal results of an integrated and multidisciplinary analysis of the health parameters and assess the mercury (Hg) [...] Read more.
The Amazonian indigenous peoples depend on natural resources to live, but human activities’ growing impacts threaten their health and livelihoods. Our objectives were to present the principal results of an integrated and multidisciplinary analysis of the health parameters and assess the mercury (Hg) exposure levels in indigenous populations in the Brazilian Amazon. We carried out a cross-sectional study based on a census of three Munduruku indigenous villages (Sawré Muybu, Poxo Muybu, and Sawré Aboy), located in the Sawré Muybu Indigenous Land, between 29 October and 9 November 2019. The investigation included: (i) sociodemographic characterization of the participants; (ii) health assessment; (iii) genetic polymorphism analysis; (iv) hair mercury determination; and (v) fish mercury determination. We used the logistic regression model with conditional Prevalence Ratio (PR), with the respective 95% confidence intervals (CI95%) to explore factors associated with mercury exposure levels ≥6.0 µg/g. A total of 200 participants were interviewed. Mercury levels (197 hair samples) ranged from 1.4 to 23.9 μg/g, with significant differences between the villages (Kruskal–Wallis test: 19.9; p-value < 0.001). On average, the general prevalence of Hg exposure ≥ 6.0 µg/g was 57.9%. For participants ≥12 years old, the Hg exposure ≥6.0 µg/g showed associated with no regular income (PR: 1.3; CI95%: 1.0–1.8), high blood pressure (PR: 1.6; CI95%: 1.3–2.1) and was more prominent in Sawré Aboy village (PR: 1.8; CI95%: 1.3–2.3). For women of childbearing age, the Hg exposure ≥6.0 µg/g was associated with high blood pressure (PR: 1.9; CI95%: 1.2–2.3), with pregnancy (PR: 1.5; CI95%: 1.0–2.1) and was more prominent among residents in Poxo Muybu (PR: 1.9; CI95%: 1.0–3.4) and Sawré Aboy (PR: 2.5; CI95%: 1.4–4.4) villages. Our findings suggest that chronic mercury exposure causes harmful effects to the studied indigenous communities, especially considering vulnerable groups of the population, such as women of childbearing age. Lastly, we propose to stop the illegal mining in these areas and develop a risk management plan that aims to ensure the health, livelihoods, and human rights of the indigenous people from Amazon Basin. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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14 pages, 1530 KiB  
Article
Intergenerational Association of Short Maternal Stature with Stunting in Yanomami Indigenous Children from the Brazilian Amazon
by Jesem Douglas Yamall Orellana, Giovanna Gatica-Domínguez, Juliana dos Santos Vaz, Paulo Augusto Ribeiro Neves, Ana Claudia Santiago de Vasconcellos, Sandra de Souza Hacon and Paulo Cesar Basta
Int. J. Environ. Res. Public Health 2021, 18(17), 9130; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179130 - 30 Aug 2021
Cited by 10 | Viewed by 2519
Abstract
To describe the factors associated to stunting in <5-year-old Yanomami Brazilian children, and to evaluate the association of short maternal stature to their offspring’s stunting. A cross-sectional study carried out in three villages in the Yanomami territory. We performed a census, in which [...] Read more.
To describe the factors associated to stunting in <5-year-old Yanomami Brazilian children, and to evaluate the association of short maternal stature to their offspring’s stunting. A cross-sectional study carried out in three villages in the Yanomami territory. We performed a census, in which all households with children < 5-years-old were included. The length/height-for-age z-score <−2 standard deviations was used to classify the children as stunted. Short maternal height was defined as <145 cm for adult women, and <−2 standard deviations of the height-for-age z-score for adolescent women. We used adjusted Poisson regression models to estimate prevalence ratios (PR) along the 90% confidence interval. We evaluated 298 children. 81.2% of children suffered from stunting and 71.9% of the mothers from short stature. In the bivariate analysis, a significant association of stunting with short maternal stature, gestational malaria and child’s place of birth were observed. Considering the variables of the children under five years of age, there were significant associations with age group, the child’s caregiver, history of malaria, pneumonia, and malnutrition treatment. In the adjusted hierarchical model, stunting was 1.22 times greater in the offspring of women with a short stature (90% CI: 1.07–1.38) compared to their counterparts. Brazilian Amazonian indigenous children living in a remote area displayed an alarming prevalence of stunting, and this was associated with short maternal height, reinforcing the hypothesis of intergenerational chronic malnutrition transmission in this population. In addition, children above 24 months of age, who were born in the village healthcare units and who had had previous treatment in the past for stunting presented higher rates of stunting in this study. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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18 pages, 563 KiB  
Article
Impacts of the Goldmining and Chronic Methylmercury Exposure on the Good-Living and Mental Health of Munduruku Native Communities in the Amazon Basin
by Rafaela Waddington Achatz, Ana Claudia Santiago de Vasconcellos, Lucia Pereira, Paulo Victor de Sousa Viana and Paulo Cesar Basta
Int. J. Environ. Res. Public Health 2021, 18(17), 8994; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18178994 - 26 Aug 2021
Cited by 8 | Viewed by 2515
Abstract
This paper is an exploratory study that examines the illegal goldmining impacts on Munduruku communities’ “Good-Living” (Xipan Jewewekukap) and explores the possible relationship between chronic methylmercury (MeHg) exposure and the worsening mental health conditions in three villages in the Middle-Tapajós River, [...] Read more.
This paper is an exploratory study that examines the illegal goldmining impacts on Munduruku communities’ “Good-Living” (Xipan Jewewekukap) and explores the possible relationship between chronic methylmercury (MeHg) exposure and the worsening mental health conditions in three villages in the Middle-Tapajós River, Brazilian Amazon. The region has been experiencing a long-lasting threat of goldminers’ invasions. A total of 109 people were interviewed and evaluated. Total mercury (THg) exposure levels were evaluated through hair samples analysis, from which MeHg exposure levels were calculated. The Geriatric Depression Scale—Short Form (GDS-SF) was used as a screening tool in order to assess mental health indicators. Brief non-structured interviews were carried out to investigate how goldmining is impacting the communities Good-Living. A Poisson regression model was used to estimate the possible association between mental health indicators (assessed through the GDS-SF) and the following independent variables: (i) mercury exposure level (<10.0 μg/g vs. ≥10.0 μg/g), (ii) self-reported nervousness, (iii) self-reported irritability, (iv) age group, and (v) monthly income. The analysis revealed high levels of mercury in hair samples (median: 7.4 µg/g, range 2.0–22.8; 70% and 28% of the participants had THg levels ≥6.0 and ≥10.0 µg/g, respectively) and pointed to a tendency in which higher levels of methylmercury exposure (Hg ≥ 10.0 µg/g) could be linked to worse mental health indicators. Although the GDS-SF has presented limitations due to the Munduruku sociocultural context, our findings suggest a tendency of worse mental health indicators in participants presenting high levels of MeHg exposure. Despite this limitation, the qualitative approach indicates an evident association between the impacts of goldmining and the Munduruku people’s decreasing autonomy to maintain a Good-Living on their own terms, pointing to the importance of carrying out new investigations, especially considering longitudinal studies with qualitative methodologies and ethnographic approaches. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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12 pages, 403 KiB  
Article
Genetic Polymorphism of Delta Aminolevulinic Acid Dehydratase (ALAD) Gene and Symptoms of Chronic Mercury Exposure in Munduruku Indigenous Children within the Brazilian Amazon
by Jamila Alessandra Perini, Mayara Calixto Silva, Ana Claudia Santiago de Vasconcellos, Paulo Victor Sousa Viana, Marcelo Oliveira Lima, Iracina Maura Jesus, Joseph William Kempton, Rogério Adas Ayres Oliveira, Sandra Souza Hacon and Paulo Cesar Basta
Int. J. Environ. Res. Public Health 2021, 18(16), 8746; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18168746 - 19 Aug 2021
Cited by 10 | Viewed by 2317
Abstract
Genetic polymorphisms involved in mercury toxicokinetics and toxicodynamics may be associated with severe mercury toxicity. This study aimed to investigate the impact of an ALAD polymorphism on chronic mercury exposure and the health situation of indigenous children from the Brazilian Amazon. One-hundred-and-three indigenous [...] Read more.
Genetic polymorphisms involved in mercury toxicokinetics and toxicodynamics may be associated with severe mercury toxicity. This study aimed to investigate the impact of an ALAD polymorphism on chronic mercury exposure and the health situation of indigenous children from the Brazilian Amazon. One-hundred-and-three indigenous children (under 15 years old) were included and genotyped (rs1800435) using a TaqMan validated assay. The mean age was 6.6 ± 4.5 years old, 60% were female, 49% presented with anemia, and the mean hair mercury concentration was 7.0 ± 4.5 (1.4–23.9) µg/g, with 49% exceeding the reference limit (≥6.0 µg/g). Only two children were heterozygous ALAD, while the others were all wild type. Minor allele frequency (ALAD G) and heterozygous genotype (ALAD CG) were 1% and 2%, respectively. The two children (12 and 14 years old) with the ALAD polymorphism had mercury levels above the average as well as had neurological symptoms related to chronic mercury exposure, such as visual field alterations, memory deficit, distal neuropathy, and toe amyotrophy. Both children also reported frequent consumption of fish in the diet, at least three times a week. In conclusion, our data confirm that an ALAD polymorphism can contribute to mercury half-life time, harmful effects, and neuropsychological disorders in indigenous children with chronic mercury exposure to gold mining activity. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
16 pages, 840 KiB  
Article
Health Risk Assessment of Mercury Exposure from Fish Consumption in Munduruku Indigenous Communities in the Brazilian Amazon
by Ana Claudia Santiago de Vasconcellos, Gustavo Hallwass, Jaqueline Gato Bezerra, Angélico Nonato Serrão Aciole, Heloisa Nascimento de Moura Meneses, Marcelo de Oliveira Lima, Iracina Maura de Jesus, Sandra de Souza Hacon and Paulo Cesar Basta
Int. J. Environ. Res. Public Health 2021, 18(15), 7940; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18157940 - 27 Jul 2021
Cited by 22 | Viewed by 4572
Abstract
Fish serves as the principal source of animal protein for the indigenous people of the Amazon, ensuring their food and nutritional security. However, gold mining causes mercury (Hg) contamination in fish, and consequently increases health risks associated with fish consumption. The aim of [...] Read more.
Fish serves as the principal source of animal protein for the indigenous people of the Amazon, ensuring their food and nutritional security. However, gold mining causes mercury (Hg) contamination in fish, and consequently increases health risks associated with fish consumption. The aim of this study was to assess the health risk attributed to the consumption of mercury-contaminated fish by Munduruku indigenous communities in the Middle-Tapajós Region. Different fish species were collected in the Sawré Muybu Indigenous Land to determine mercury levels. The health risk assessment was carried out according to the World Health Organization (WHO 2008) methodology and different scenarios were built for counterfactual analysis. Eighty-eight fish specimens from 17 species and four trophic levels were analyzed. Estimates of Hg ingestion indicated that the methylmercury daily intake exceeds the U.S. EPA (United States Environmental Protection Agency) (2000) reference dose from 3 to 25-fold, and up to 11 times the FAO (Food and Agriculture Organization)/WHO (2003) dose recommendation. In all situations analyzed, the risk ratio estimates were above 1.0, meaning that the investigated Munduruku communities are at serious risk of harm as a result of ingestion of mercury-contaminated fish. These results indicate that, at present, fish consumption is not safe for this Munduruku population. This hazardous situation threatens the survival of this indigenous population, their food security, and their culture. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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19 pages, 3087 KiB  
Article
Analyzing Spatial Patterns of Health Vulnerability to Drought in the Brazilian Semiarid Region
by Júlia Alves Menezes, Ana Paula Madureira, Rhavena Barbosa dos Santos, Isabela de Brito Duval, Pedro Regoto, Carina Margonari, Martha Macêdo de Lima Barata and Ulisses Confalonieri
Int. J. Environ. Res. Public Health 2021, 18(12), 6262; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126262 - 09 Jun 2021
Cited by 3 | Viewed by 2411
Abstract
Health determinants might play an important role in shaping the impacts related to long-term disasters such as droughts. Understanding their distribution in populated dry regions may help to map vulnerabilities and set coping strategies for current and future threats to human health. The [...] Read more.
Health determinants might play an important role in shaping the impacts related to long-term disasters such as droughts. Understanding their distribution in populated dry regions may help to map vulnerabilities and set coping strategies for current and future threats to human health. The aim of the study was to identify the most vulnerable municipalities of the Brazilian semiarid region when it comes to the relationship between drought, health, and their determinants using a multidimensional index. From a place-based framework, epidemiological, socio-economic, rural, and health infrastructure data were obtained for 1135 municipalities in the Brazilian semiarid region. An exploratory factor analysis was used to reduce 32 variables to four independent factors and compute a Health Vulnerability Index. The health vulnerability was modulated by social determinants, rural characteristics, and access to water in this semiarid region. There was a clear distinction between municipalities with the highest human welfare and economic development and those municipalities with the worst living conditions and health status. Spatial patterns showed a cluster of the most vulnerable municipalities in the western, eastern, and northeastern portions of the semiarid region. The spatial visualization of the associated vulnerabilities supports decision making on health promotion policies that should focus on reducing social inequality. In addition, policymakers are presented with a simple tool to identify populations or areas with the worst socioeconomic and health conditions, which can facilitate the targeting of actions and resources on a more equitable basis. Further, the results contribute to the understanding of social determinants that may be related to medium- and long-term health outcomes in the region. Full article
(This article belongs to the Special Issue Environmental and Occupational Health in Brazil)
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