Resumo O uso de agrotóxicos na agricultura brasileira é um problema de saúde pública, dadas as contaminações no ambiente, em alimentos e as intoxicações na saúde humana. Objetivou-se apresentar a ...distribuição espacial da área plantada de lavouras, consumo de agrotóxicos e agravos à saúde relacionados, como estratégia de Vigilância em Saúde. Obteve-se dados de área plantada de 21 culturas predominantes, indicadores de consumo de agrotóxicos por hectare para cada cultura e agravos à saúde. Espacializou-se o consumo de agrotóxicos nos municípios brasileiros e correlacionou-se às incidências de intoxicações por agrotóxicos: aguda, subaguda e crônica. Constatou-se predomínio dos cultivos de soja, milho e cana, que juntos corresponderam a 76% da área plantada no Brasil em 2015. Pulverizou-se 899 milhões de litros de agrotóxicos nessas lavouras, com Mato Grosso, Paraná e Rio Grande Sul tendo utilizado as maiores quantidades. Os agravos à saúde apresentaram correlações positivas e significativas com o uso de agrotóxicos. A estratégia metodológica possibilitou identificar municípios prioritários para a Vigilância em Saúde e o desenvolvimento de ações intersetoriais de prevenção e mitigação dos impactos dos agrotóxicos na saúde e ambiente.
To help inform policy discussions about postpandemic telemedicine reimbursement and regulations, we conducted dual nationally representative surveys among primary care physicians and patients. ...Although majorities of both populations reported satisfaction with video visits during the pandemic, 80 percent of physicians would prefer to provide only a small share of care or no care via telemedicine in the future, and only 36 percent of patients would prefer to seek care by video or phone. Most physicians (60 percent) felt that the quality of video telemedicine care was generally inferior to the quality of in-person care, and both patients and physicians cited the lack of physical exam as a key reason (90 percent and 92 percent, respectively). Patients who were older, had less education, or were Asian were less likely to want to use video for future care. Although improvements to home-based diagnostic tools could improve both the quality of and the desire to use telemedicine, virtual primary care will likely be limited in the immediate future. Policies to enhance quality, sustain virtual care, and address inequities in the online setting may be needed.
Background: In May 2010, a team of national and international organizations was assembled to investigate children's deaths due to lead poisoning in villages in northwestern Nigeria. Objectives: Our ...goal was to determine the cause of the childhood lead poisoning outbreak, investigate risk factors for child mortality, and identify children < 5 years of age in need of emergency chelation therapy for lead poisoning. Methods: We administered a cross-sectional, door-to-door questionnaire in two affected villages, collected blood from children 2-59 months of age, and obtained soil samples from family compounds. Descriptive and bivariate analyses were performed with survey, blood lead, and environmental data. Multivariate logistic regression techniques were used to determine risk factors for childhood mortality. Results: We surveyed 119 family compounds. Of 463 children < 5 years of age, 118 (25%) had died in the previous year. We tested 59% (204/345) of children < 5 years of age, and all were lead poisoned (≥ 10 μg/dL); 97% (198/204) of children had blood lead levels (BLLs) ≥ 45 μg/dL, the threshold for initiating chelation therapy. Gold ore was processed inside two-thirds of the family compounds surveyed. In multivariate modeling, significant risk factors for death in the previous year from suspected lead poisoning included the age of the child, the mother's work at ore-processing activities, community well as primary water source, and the soil lead concentration in the compound. Conclusion: The high levels of environmental contamination, percentage of children < 5 years of age with elevated BLLs (97%, > 45 μg/dL), and incidence of convulsions among children before death (82%) suggest that most of the recent childhood deaths in the two surveyed villages were caused by acute lead poisoning from gold ore–processing activities. Control measures included environmental remediation, chelation therapy, public health education, and control of mining activities.
Purpose
Several interactions between Al and the solid phase of soil influence Al buffering in soil solution. This work evaluated soils cultivated with
Pinus taeda
L. to determine Al forms in organic ...and mineral horizons using various extraction methods and to relate acidity with clay mineralogy.
Materials and methods
Organic and mineral horizons of 10 soil profiles (up to 2.1 m deep) in southern Brazil were sampled. Organic horizons were separated into fresh, aged, and fermented/humified litter. The following Al extraction methods were utilized: 0.5 mol L
−1
pH 2.8 CuCl
2
–Al complexed in organic matter; 1.0 mol L
−1
KCl–exchangeable Al; water–Al soluble in soil solution; HF concentrated + HNO
3
concentrated + H
2
O
2
30% (
v
/
v
)–total Al. Six sequential extractions were carried out to isolate different forms of amorphous minerals that can buffer Al on soil solution: 0.05 and 0.1 mol L
−1
sodium pyrophosphate; 0.1 and 0.2 mol L
−1
ammonium oxalate; 0.25 and 0.5 mol L
−1
NaOH. Samples of clay were also analyzed by XRD.
Results and discussion
There was a clear effect of litter age on increasing total Al concentration. In the aged litter and fermented and/or humified litter, levels of total Al were 1.4 to 3.8 and 1.5 to 7.8 times greater than in fresh litter, respectively. The CuCl
2
method had higher Al extraction capacity than the KCl method for litter. The lowest Al–pyrophosphate values were observed in the Oxisol, which also had a predominance of gibbsite and the lowest levels of Al–KCl and Al–CuCl
2
. There was an inverse relationship between degree of soil weathering and soluble and exchangeable Al in soils. Available Al increased with higher Si proportion in minerals of the clay fraction (2:1 > 1:1 > 0:1).
Conclusions
The worst scenario was soils with the combination of high soluble and exchangeable Al levels and high concentrations of amorphous forms of Al minerals. The best predictors of Al accumulation in the youngest litter horizon were extractions of amorphous minerals with pyrophosphate and NaOH. These extractors are normally used to predict the level of Al buffering in soils. Organic matter had less influence on Al dynamics in soils.
In 2020, at the onset of the COVID-19 pandemic, the United States experienced surges in healthcare needs, which challenged capacity throughout the healthcare system. Stay-at-home orders in many ...jurisdictions, cancellation of elective procedures, and closures of outpatient medical offices disrupted patient access to care. To inform symptomatic persons about when to seek care and potentially help alleviate the burden on the healthcare system, Centers for Disease Control and Prevention (CDC) and partners developed the CDC Coronavirus Self-Checker ("Self-Checker"). This interactive tool assists individuals seeking information about COVID-19 to determine the appropriate level of care by asking demographic, clinical, and nonclinical questions during an online "conversation."
This paper describes user characteristics, trends in use, and recommendations delivered by the Self-Checker between March 23, 2020, and April 19, 2021, for pursuing appropriate levels of medical care depending on the severity of user symptoms.
User characteristics and trends in completed conversations that resulted in a care message were analyzed. Care messages delivered by the Self-Checker were manually classified into three overarching conversation themes: (1) seek care immediately; (2) take no action, or stay home and self-monitor; and (3) conversation redirected. Trends in 7-day averages of conversations and COVID-19 cases were examined with development and marketing milestones that potentially impacted Self-Checker user engagement.
Among 16,718,667 completed conversations, the Self-Checker delivered recommendations for 69.27% (n=11,580,738) of all conversations to "take no action, or stay home and self-monitor"; 28.8% (n=4,822,138) of conversations to "seek care immediately"; and 1.89% (n=315,791) of conversations were redirected to other resources without providing any care advice. Among 6.8 million conversations initiated for self-reported sick individuals without life-threatening symptoms, 59.21% resulted in a recommendation to "take no action, or stay home and self-monitor." Nearly all individuals (99.8%) who were not sick were also advised to "take no action, or stay home and self-monitor."
The majority of Self-Checker conversations resulted in advice to take no action, or stay home and self-monitor. This guidance may have reduced patient volume on the medical system; however, future studies evaluating patients' satisfaction, intention to follow the care advice received, course of action, and care modality pursued could clarify the impact of the Self-Checker and similar tools during future public health emergencies.
Telehealth is the use of electronic information and telecommunication technologies to provide care when the patient and the provider are not in the same room at the same time. Telehealth accounted ...for less than 1% of all Medicare Fee-for-Service outpatient visits in the United States in 2019 but grew to account for 46% of all visits in April 2020. Changes in reimbursement and licensure policies during the COVID-19 pandemic appeared to greatly facilitate this increased use. Telehealth will continue to account for a substantial portion of care provided in the United States and globally. A better understanding of telehealth approaches and their evidence base by public health practitioners may help improve their ability to collaborate with health care organizations to improve population health. The article summarizes the Centers for Disease Control and Prevention's (CDC's) approach to understanding the evidence base for telehealth in public health practice, possible applications for telehealth in public health practice, and CDC's use of telehealth to improve population health.
BACKGROUND
Comparative effectiveness studies of state tobacco quitlines and Web‐based tobacco cessation interventions are limited. In 2009, the US Centers for Disease Control and Prevention undertook ...a study of the comparative effectiveness of state quitlines and Web‐based tobacco cessation interventions.
METHODS
Standardized questionnaires were administered to smokers who enrolled exclusively in either quitlines or Web‐based tobacco cessation services in 4 states in 2011‐2012. The primary outcome was the 30‐day point prevalence abstinence (PPA) rate at 7 months both between and within interventions.
RESULTS
A total of 4086 participants were included in the analysis. Quitline users were significantly older, more heterogeneous in terms of race and ethnicity, less educated, less likely to be employed, and more often single than Web‐based users. The 7‐month 30‐day PPA rate was 32% for quitline users and 27% for Web‐based users. Multivariate models comparing 30‐day PPA rates between interventions indicated that significantly increased odds of quitting were associated with being partnered, not living with another smoker, low baseline cigarette use, and more interactions with the intervention. After adjustments for demographic and tobacco use characteristics, quitline users had 1.26 the odds of being abstinent in comparison with Web‐based users (95% confidence interval, 1.00‐1.58; P = .053).
CONCLUSIONS
This is one of the largest comparative effectiveness studies of state tobacco cessation interventions to date. These findings will help public health agencies develop and tailor evidence‐based tobacco cessation programs. Further research should focus on users of Web‐based cessation interventions sponsored by state health departments and their cost‐effectiveness. Cancer 2016;122:1126–1133. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
Limited information exists for comparing state quitlines and Web‐based tobacco cessation interventions. Exclusive users of quitlines and Web‐based interventions are different with respect to demographics and tobacco use. The intervention type approaches but does not meet statistical significance as a factor associated with 30‐day abstinence measured at 7 months' follow‐up in a model adjusted for demographics and tobacco use.
In 2010, Médecins Sans Frontières discovered a lead poisoning outbreak linked to artisanal gold processing in northwestern Nigeria. The outbreak has killed approximately 400 young children and ...affected thousands more.
Our aim was to undertake an interdisciplinary geological- and health-science assessment to clarify lead sources and exposure pathways, identify additional toxicants of concern and populations at risk, and examine potential for similar lead poisoning globally.
We applied diverse analytical methods to ore samples, soil and sweep samples from villages and family compounds, and plant foodstuff samples.
Natural weathering of lead-rich gold ores before mining formed abundant, highly gastric-bioaccessible lead carbonates. The same fingerprint of lead minerals found in all sample types confirms that ore processing caused extreme contamination, with up to 185,000 ppm lead in soils/sweep samples and up to 145 ppm lead in plant foodstuffs. Incidental ingestion of soils via hand-to-mouth transmission and of dusts cleared from the respiratory tract is the dominant exposure pathway. Consumption of water and foodstuffs contaminated by the processing is likely lesser, but these are still significant exposure pathways. Although young children suffered the most immediate and severe consequences, results indicate that older children, adult workers, pregnant women, and breastfed infants are also at risk for lead poisoning. Mercury, arsenic, manganese, antimony, and crystalline silica exposures pose additional health threats.
Results inform ongoing efforts in Nigeria to assess lead contamination and poisoning, treat victims, mitigate exposures, and remediate contamination. Ore deposit geology, pre-mining weathering, and burgeoning artisanal mining may combine to cause similar lead poisoning disasters elsewhere globally.
RESUMO As etapas que envolvem a cadeia produtiva de commodities agrícolas produzem possibilidades diferenciadas de vulnerabilidade nas populações, afetando a situação de saúde dos povos indígenas. O ...uso de agrotóxicos é uma atividade intrínseca aos monocultivos. A exposição a essas substâncias gera desfechos negativos agudos e crônicos na saúde humana e contaminação no ambiente. De modo a contribuir com o debate no campo da Saúde Coletiva, o texto direciona as discussões ao estado de Mato Grosso, onde estão vários povos indígenas, enfrentando a produção de commodities e desfechos em saúde relacionados com os agrotóxicos. Para isso, recorremos à determinação socioambiental do processo saúde-doença, organizando uma matriz de indicadores que enfatizam as escolhas e as omissões do Estado nas questões ambientais, incorporando historicidade nos processos de adoecimento. Os impactos da cadeia de commodities agrícolas e as exposições por agrotóxicos em territórios indígenas são um problema intersetorial que se vincula a violação de direitos humanos, direito à terra, à saúde e à segurança alimentar e nutricional. As respostas devem ser consideradas em uma perspectiva articulada entre os setores econômico, político, ambiental e da saúde, com participação e decisão da população indígena nas etapas dos processos.
ABSTRACT The stages involving the agricultural supply chain produce different possibilities of vulnerability in populations, affecting the health situation of indigenous peoples. The use of pesticides is an activity intrinsic to monocultures. The exposure to these substances generates acute and chronic negative outcomes in human health and contamination in the environment. In order to contribute to the debate in Public Health, the text directs the discussions to the state of Mato Grosso, where are several indigenous peoples, facing the production of commodities and health outcomes associated to pesticides. For that, we resort to the socio-environmental determination of the health-disease process, organizing a matrix of indicators that emphasize the choices and omissions of the State in environmental issues, incorporating historicity in the processes of illness. The impacts of the agricultural commodities chain and exposures by pesticides in indigenous territories are an intersectoral problem that is linked to the violation of basic social rights, such as the right to land, health, and food and nutritional security. The responses must be considered in an articulated perspective between the economic, political, environmental, and health sectors, with participation and decision by the indigenous population in the stages of the processes.
In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead ...poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response.
We included children aged ≤5 years with VBLL ≥45 µg/dL before any chelation and recorded neurological status. Odds ratios (OR) for neurological features were estimated; the final model was adjusted for age and baseline VBLL, using random effects for village of residence. 972 children met inclusion criteria: 885 (91%) had no neurological features; 34 (4%) had severe features; 47 (5%) had reported recent seizures; and six (1%) had other neurological abnormalities. The geometric mean VBLLs for all groups with neurological features were >100 µg/dL vs 65.9 µg/dL for those without neurological features. The adjusted OR for neurological features increased with increasing VBLL: from 2.75, 95%CI 1.27-5.98 (80-99.9 µg/dL) to 22.95, 95%CI 10.54-49.96 (≥120 µg/dL). Neurological features were associated with younger age (OR 4.77 95% CI 2.50-9.11 for 1-<2 years and 2.69 95%CI 1.15-6.26 for 2-<3 years, both vs 3-5 years). Severe neurological features were seen at VBLL <105 µg/dL only in those with malaria.
Increasing VBLL (from ≥80 µg/dL) and age 1-<3 years were strongly associated with neurological features; in those tested for malaria, a positive test was also strongly associated. These factors will help clinicians managing children with lead poisoning in prioritising therapy and developing chelation protocols.
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