INTRODUÇÃO: Atualmente inexiste no Brasil, uma correlação entre a área da saúde e o direito, no que tange a adoção de políticas públicas tendentes a prevenir/evitar, remediar ou minimizar os efeitos adversos da poluição atmosférica na saúde humana. OBJETIVO: O presente trabalho tem como objetivo evidenciar a necessidade cada vez mais iminente da interação entre a epidemiologia e o direito, revelando estas áreas, não como ciências autônomas, mas como instrumentos integrados, a serem utilizados na busca de políticas públicas eficientes, em matéria de poluição atmosférica causada por veículos automotores. MÉTODOS: Elaboramos uma revisão sistemática dos estudos epidemiológicos referentes aos efeitos da poluição atmosférica na saúde humana utilizando como base de dados o PubMed, por meio de descritores bem definidos. Esta revisão foi submetida posteriormente a seleção de três pesquisadores independentes com experiência no tema. Foi realizada uma revisão da legislação ambiental nacional relativa à poluição atmosférica, em base de dados oficiais, incluindo normas CONAMA (Conselho Nacional de Meio Ambiente) e pesquisa dos documentos internacionais relativos aos padrões de emissão atmosférica. Realizamos entrevistas estruturadas com formuladores de políticas públicas na área ambiental, com o fim de análise das opiniões dos representantes desses segmentos distintos da sociedade, sobre o tema em questão. RESULTADO: Dos 2.530 estudos selecionados inicialmente apenas 32 nacionais e 112 internacionais foram considerados adequados aos critérios de inclusão estabelecidos. Dos estudos nacionais 27 evidenciaram efeitos adversos na saúde humana, mesmo em concentrações menores do que as permitidas legalmente e 18 discutiram de alguma maneira políticas públicas. Dos estudos internacionais 78 evidenciaram efeitos adversos na saúde humana, mesmo em concentrações menores do que as permitidas legalmente e 13 discutiram políticas públicas. Em relação aos entrevistados, todos foram uníssonos quanto à necessidade de atualização dos atuais padrões de emissão; quanto ao dever de cumprimento do cronograma de emissões e em relação à falta de entendimento adequado entre a área da saúde e a adoção de medidas de políticas públicas, mostrando conhecimento das pesquisas científicas realizadas e sua preocupação com os dados apresentados. CONCLUSÃO: Evidenciamos então: a necessidade de uma composição entre direito e epidemiologia para elaboração de diretrizes públicas; a necessidade de conscientização da população e alteração dos padrões de emissão e a participação efetiva dos órgãos públicos do segmento político e da saúde. A identificação, reconhecimento e aceitação da complexidade e dos dados das pesquisas são peças chave na interface entre os domínios da ciência, da sociedade e da política / INTRODUCTION: Currently, there is no correlation between the fields of healthcare and law in Brazil regarding the adoption of public policies aimed at preventing/avoiding, remedying or minimizing the adverse effects of atmospheric pollution on human health. OBJECTIVE: The present study had the objective of demonstrating the increasingly eminent need for interaction between epidemiology and law, thereby revealing that these fields are not autonomous sciences but integrated instruments for use in seeking efficient public policies relating to atmospheric pollution caused by automotive vehicles. METHODS: We built up a systematic review of epidemiological studies relating to the effects of atmospheric pollution on human health, using the PubMed database and well-defined descriptors. The search results then underwent selection by three independent researchers with experience of this topic. A review of the national environmental legislation relating to atmospheric pollution was made, using official databases, including the CONAMA (National Environment Council) standards, and international documents relating to atmospheric emission standards were investigated. We conducted structured interviews with public policymakers in the environmental field, with a view to analyzing the opinions of representatives of this distinct segment of society regarding the matter in question. RESULT: Out of 2,530 studies initially selected, only 32 Brazilian and 112 foreign studies were considered to fit within the inclusion criteria established. Among the Brazilian studies, 27 showed that there were adverse effects on human health even at concentrations lower than what is legally permitted, and 18 discussed public policies in some manner. Among the foreign studies, 78 showed that there were adverse effects on human health even at concentrations lower than what is legally permitted, and 13 discussed public policies. The interviewees unanimously stated that there was a need to update the current emission standards and comply with the emissions timetable, and that there was inadequate understanding between the field of healthcare and the adoption of public policy measures. They showed that they were aware of the scientific research that had been conducted and were concerned about the data presented. CONCLUSION: We thus demonstrated that: there is a need for law and epidemiology to combine in order to draw up public guidelines; a need for the populations awareness to be raised, and for emission standards to be changed and the effective participation from public bodies within the policymaking and healthcare sectors. Identification, recognition and acceptance of the complexity and the research data are the cornerstones of the interface between the domains of science, society and politics

INTRODUÇÃO: Atualmente inexiste no Brasil, uma correlação entre a área da saúde e o direito, no que tange a adoção de políticas públicas tendentes a prevenir/evitar, remediar ou minimizar os efeitos adversos da poluição atmosférica na saúde humana. OBJETIVO: O presente trabalho tem como objetivo evidenciar a necessidade cada vez mais iminente da interação entre a epidemiologia e o direito, revelando estas áreas, não como ciências autônomas, mas como instrumentos integrados, a serem utilizados na busca de políticas públicas eficientes, em matéria de poluição atmosférica causada por veículos automotores. MÉTODOS: Elaboramos uma revisão sistemática dos estudos epidemiológicos referentes aos efeitos da poluição atmosférica na saúde humana utilizando como base de dados o PubMed, por meio de descritores bem definidos. Esta revisão foi submetida posteriormente a seleção de três pesquisadores independentes com experiência no tema. Foi realizada uma revisão da legislação ambiental nacional relativa à poluição atmosférica, em base de dados oficiais, incluindo normas CONAMA (Conselho Nacional de Meio Ambiente) e pesquisa dos documentos internacionais relativos aos padrões de emissão atmosférica. Realizamos entrevistas estruturadas com formuladores de políticas públicas na área ambiental, com o fim de análise das opiniões dos representantes desses segmentos distintos da sociedade, sobre o tema em questão. RESULTADO: Dos 2.530 estudos selecionados inicialmente apenas 32 nacionais e 112 internacionais foram considerados adequados aos critérios de inclusão estabelecidos. Dos estudos nacionais 27 evidenciaram efeitos adversos na saúde humana, mesmo em concentrações menores do que as permitidas legalmente e 18 discutiram de alguma maneira políticas públicas. Dos estudos internacionais 78 evidenciaram efeitos adversos na saúde humana, mesmo em concentrações menores do que as permitidas legalmente e 13 discutiram políticas públicas. Em relação aos entrevistados, todos foram uníssonos quanto à necessidade de atualização dos atuais padrões de emissão; quanto ao dever de cumprimento do cronograma de emissões e em relação à falta de entendimento adequado entre a área da saúde e a adoção de medidas de políticas públicas, mostrando conhecimento das pesquisas científicas realizadas e sua preocupação com os dados apresentados. CONCLUSÃO: Evidenciamos então: a necessidade de uma composição entre direito e epidemiologia para elaboração de diretrizes públicas; a necessidade de conscientização da população e alteração dos padrões de emissão e a participação efetiva dos órgãos públicos do segmento político e da saúde. A identificação, reconhecimento e aceitação da complexidade e dos dados das pesquisas são peças chave na interface entre os domínios da ciência, da sociedade e da política / INTRODUCTION: Currently, there is no correlation between the fields of healthcare and law in Brazil regarding the adoption of public policies aimed at preventing/avoiding, remedying or minimizing the adverse effects of atmospheric pollution on human health. OBJECTIVE: The present study had the objective of demonstrating the increasingly eminent need for interaction between epidemiology and law, thereby revealing that these fields are not autonomous sciences but integrated instruments for use in seeking efficient public policies relating to atmospheric pollution caused by automotive vehicles. METHODS: We built up a systematic review of epidemiological studies relating to the effects of atmospheric pollution on human health, using the PubMed database and well-defined descriptors. The search results then underwent selection by three independent researchers with experience of this topic. A review of the national environmental legislation relating to atmospheric pollution was made, using official databases, including the CONAMA (National Environment Council) standards, and international documents relating to atmospheric emission standards were investigated. We conducted structured interviews with public policymakers in the environmental field, with a view to analyzing the opinions of representatives of this distinct segment of society regarding the matter in question. RESULT: Out of 2,530 studies initially selected, only 32 Brazilian and 112 foreign studies were considered to fit within the inclusion criteria established. Among the Brazilian studies, 27 showed that there were adverse effects on human health even at concentrations lower than what is legally permitted, and 18 discussed public policies in some manner. Among the foreign studies, 78 showed that there were adverse effects on human health even at concentrations lower than what is legally permitted, and 13 discussed public policies. The interviewees unanimously stated that there was a need to update the current emission standards and comply with the emissions timetable, and that there was inadequate understanding between the field of healthcare and the adoption of public policy measures. They showed that they were aware of the scientific research that had been conducted and were concerned about the data presented. CONCLUSION: We thus demonstrated that: there is a need for law and epidemiology to combine in order to draw up public guidelines; a need for the populations awareness to be raised, and for emission standards to be changed and the effective participation from public bodies within the policymaking and healthcare sectors. Identification, recognition and acceptance of the complexity and the research data are the cornerstones of the interface between the domains of science, society and politics

Diss. Linköping : Linköpings universitet, 2005.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

<p>Kvalitet vazduha u urbanim sredinama predstavlja jedan od glavnih uzroka zdravstvenih problema. Prema podacima SZO u svetu se godi&scaron;nje usled zagađenja vazduha u urbanim sredinama dogodi preko 2,7 miliona smrtnih slučajeva. Procenjuje se da najbolji indikator za procenu veličine zdravstvenog rizika od zagađenja vazduha jeste koncentracija suspendovanih čestica PM2,5 u vazduhu životne sredine. Cilj: Proceniti uticaj suspendovanih čestica PM2,5 iz vazduha životne sredine na ukupan mortalitet, kardiovaskularni i respiratorni bolnički morbiditet odraslog stanovni&scaron;tva Grada Novog Sada. Takođe, cilj istraživanja je bio da se i utvrdi koncentracija i hemijski sastav suspendovanih čestica PM2,5 u vazduhu životne sredine na teritoriji Grada Novog Sada, na dnevnom i godi&scaron;njem nivou, uzimajući u obzir i uticaj meteorolo&scaron;kih parametara. Metod: Istraživanje je sprovedeno kao prospektivna studija vremenske serije podataka o kvalitetu vazduha, meteorolo&scaron;kim parametrima i zdravstvenim ishodima, u intervalima od najmanje 30 dana tokom sva četiri godi&scaron;nja doba 2017. godine. Uzorkovanje i određivanje koncentracije i hemijskog sastava čestica PM2,5 u skladu sa propisanim standardnim metodama, je obavljeno na mernim mestima u životnoj sredini Grada Novog Sada, koja reprezentuju uticaj saobraćaja i urbanog pozadinskog područja na zagađenje vazduha životne sredine. Primenjen je Lenschow pristup za kvantifikaciju veličine doprinosa saobraćaja porastu koncentracije suspendovanih čestica PM2,5 u vazduhu životne sredine. Podaci o meteorolo&scaron;kim parametrima (temperatura vazduha, relativna vlažnost vazduha i brzina vetra), su preuzeti od Republičkog hidrometeorolo&scaron;kog zavoda Srbije. Podaci o zdravstvenim ishodima (dnevni broj umrlih i hospitalizovanih zbog kardiovaskularnih i respiratornih bolesti), za stanovni&scaron;tvo starije od 18 godina, čije mesto stanovanja pripada teritoriji Grada Novog Sada, obezbeđeni su od strane Centra za informatiku i biostatistiku u zdravstvu Instituta za javno zdravlje Vojvodine. Za procenu uticaja nezavisnih promenljivih na zavisne (ukupan mortalitet / bolnički morbiditet) primenjen je generalizovani linearni model regresione analize za vremenske serije podataka (Poason). Rezultati: Prosečna godi&scaron;nja koncentracija suspendovanih čestica PM2,5 iz vazduha životne sredine na teritoriji Grada Novog Sada je iznosila 30,27 &mu;g/m3, a srednje dnevne koncentracije 8-79&nbsp; g/m3. Približno 30% varijabilnosti srednjih dnevnih koncentracije suspendovanih čestica PM2,5 se može objasniti lokalnim meteorolo&scaron;kim uslovima. Hemijski sastav čestica na području Grada Novog Sada u najvećem procentu čini ekvivalent karbonatne frakcije čestica, zatim sekundarni neorganski aerosol i rastvorljiva organska frakcija, dok su joni rastvorljivi u vodi (kalcijum, hloridi, natrijum, kalijum i magnezijum) zastupljeni u najmanjem procentu. Prisutni izvori zagađenja vazduha životne sredine na području Grada Novog Sada su procesi sagorevanja fosilnih goriva i biomase, saobraćaj, mineralna (zemlji&scaron;na) pra&scaron;ina i sekundarno zagađenje regionalnog porekla. Doprinos saobraćaja porastu prosečne godi&scaron;nje koncentracije suspendovanih čestica PM2,5 je iznosio 40%. Masena koncentracija čestica PM2,5, kao i hemijski sastav čestica (ekvivalent karbonatne frakcije, rastvorljiva organska frakcija, joni kalijuma i kalcijuma) doprinose umiranju i oboljevanju odraslog stanovni&scaron;tva Grada Novog Sada. Na uticaj masene koncentracije i hemijskog sastava čestica PM2,5 najosetljivije su žene i stanovni&scaron;tvo starosti &ge; 65 godina, kao i mu&scaron;karci u pogledu uticaja ekvivalenta karbonatne frakcije čestica PM2,5. Zaključak: Dobijeni rezultati po prvi put opisuju zdravstveni uticaj masene koncentracije i hemijskog sastava čestica PM2,5 na području Grada Novog Sada, odnosno kvantifikuju rizik za ukupan mortalilteta i kardiovaskualrni i respiratorni morbiditet. Razumevanje uticaja suspendovanih čestica PM2,5 na oboljevanje i umiranje stanovni&scaron;tva, stratifikovanih prema starosnoj i polnoj strukturi, uz identifikaciju mogućih izvora zađenja vazduha na području Grada Novog Sada, predstavlja osnovu za razvoj javnozdravstvene politike u cilju unapređenja zdravlja stanovni&scaron;tva Grada Novog Sada.</p> / <p>Urban ambient air pollution is one of the leading causes of health problems. According to WHO data, over 2.7 million deaths occur in urban areas annually due to urban air pollution. Particulate matter PM2.5 is estimated to be the best indicator for assessing the magnitude of the health risk induces by ambient air pollution. Aim: To assess the impact of PM2.5 on total mortality, cardiovascular and respiratory hospital morbidity of the adult population of the City of Novi Sad. Also, the aim of the study was to determine the concentration and chemical composition of ambient PM 2.5 particles in the territory of the City of Novi Sad, on daily and annual bases, taking into account the impact of meteorological parameters. Method: The study was conducted as a prospective, a time series study of of data on air quality, meteorological parameters and health outcomes, at intervals of at least 30 days during all four seasons of 2017. Sampling and determination of the mass concentration and chemical composition of PM2.5 particles in accordance with the prescribed standard methods, it was performed at sampling stations in the City of Novi Sad, representing the impact of traffic and urban background impact on environmental air pollution. A Lenschow approach was used to quantify the magnitude of traffic contribution to the increase of ambient PM2.5 mass concentration. Meteorological data (air temperature, relative humidity and wind velocity) were taken from the Republic Hydrometeorological Institute of Serbia. Data on health outcomes (daily number of deaths and hospitalizations due to cardiovascular and respiratory diseases) for the population older than 18, residing within the territory of the City of Novi Sad, have been provided by the Centre for Informatics and Biostatistics, Institute of Public Health of Vojvodina. To evaluate the impact of independent variables on dependent (total mortality/hospital morbidity), a generalized linear regression model for time series data (Poisson) was applied. Results: The average annual mass concentration of PM2.5 in the territory of the City of Novi Sad was 30.27&mu;g/m3, while mean daily concentrations were 8- 79&mu;g/m3. Approximately 30% of the variability in mean daily concentrations of PM2.5 particles can be explained with local meteorological conditions. The chemical composition of PM2.5 in the area of Novi Sad is to the a great extent the equivalent of the carbonate fraction of the particles, then the secondary inorganic aerosol and the soluble organic fraction, while the water-soluble ions (calcium, chlorides, sodium, potassium and magnesium) are present in the lowest percentage. The sources of ambient air pollution in the area of the City of Novi Sad were the combustion of fossil fuels and biomass, traffic, mineral (soil dust) and secondary pollution of regional origin. Contribution of traffic to the increase of the average annual mass concentrations of PM2.5 particles was 40%. PM2.5 particle mass concentration, as well as the chemical composition of the particles (carbonate fraction equivalent, soluble organic fraction, potassium and calcium ions) contribute to the deaths and diseases of the adult population of the City of Novi Sad. Women and the population aged &ge;65, were more susceptible to mass concentration and chemical composition of PM2.5 related deaths and diseases, as well as men according to the impact of the equivalents of carbonate fractions of PM2.5. Conclusion: The results obtained show for the first time the health effects of mass concentration and chemical composition of PM2.5 particles in the City of Novi Sad, i.e. they quantify the risk for total mortality and cardiovascular and respiratory morbidity. Understanding the impact of suspended particles PM2.5 on population mortality and morbidity, stratified by age and sex structure, along with identifying of possible air pollution sources is the basis for the development of public health policies aimed at improving the population health in the City of Novi Sad.</p>

Chaque jour, 15% des Européens sont exposés à des niveaux moyens de bruit ou de polluants atmosphériquesdépassant les valeurs seuils fixées par la législation européenne. L’intensité de la pollution de chaque polluant et sarépartition à l’échelle d’une agglomération dépendent des capacités d’émission des sources, des phénomènes dedispersion, et de l’environnement urbain. Il en résulte une variabilité spatiale du niveau de multi-exposition qui resteencore largement méconnue. L’objectif de ce travail de thèse est d’identifier et de caractériser les situations de multiexpositionsur la ville de Besançon. Les niveaux sonores et les concentrations de plusieurs polluants atmosphériques denatures différentes (NO2, benzène, PM10 et PM2.5) ont été finement modélisés (2m x 2m). La compatibilité des modèlesa été maximisée par l’introduction d’inputs identiques dans les méthodologies de calcul Mithra-SIG pour le bruit, etCOPERT4/ADMS-urban pour les polluants. Dans un premier temps, l’impact de la définition du voisinage sur lesniveaux d’exposition a été exploré pour les deux pollutions. Douze indicateurs, présentant chacun une définitiondifférente de la zone d’exposition au voisinage du domicile, ont permis de quantifier les niveaux d'exposition autour des10865 bâtiments d’habitations bisontins. Les résultats obtenus mettent en évidence un impact significatif de ladéfinition de la zone d’exposition sur les niveaux. Les différentes définitions du voisinage conduisent à l'existence d'unbiais différentiel, dû à la prise en compte particulière des variables environnementales dans chacun des indicateurs. Cebiais se retrouve pour l'ensemble des polluants étudiés, bien que dans des proportions variables en fonction du polluant.Dans un second temps, l’étude des situations de multi-exposition bruit/NO2 a pu être réalisée. Les résultats obtenusindiquent l'existence d'une relation complexe et permettent de décrire les différentes situations de multi-expositionprésentes dans la ville. Ce travail de thèse constitue une des premières approches de ce type en France et permet demieux comprendre les relations existantes entre définition du voisinage, zones d'exposition, paramètresenvironnementaux et niveaux d'exposition. / Every day, 15% of the European population is exposed to average noise or air pollution levels exceeding theEuropean legal threshold. Levels and distribution of each pollutant across the city depend of individual sourcesemissions, dispersion phenomenon, and urban environment. Consequently, spatial variability of multi-exposure levelremains mostly unknown. The aim of this Ph. D. thesis is to identify and describe multi-exposure situations in the cityof Besançon. Environmental noise levels, and concentrations of several air pollutants (NO2, benzene, PM10 and PM2.5),have been modeled using a fine scale grid (2m x 2m). Model compatibility has been maximized by the use of commoninput into the calculation software Mithra-SIG (for noise) and COPERT4/ADMS-urban (for air pollutants). In a firsttime, impact of the neighborhood definition on exposure levels has been explored for both pollutions. Twelveindicators, each representing a different definition of the exposure area in the dwelling vicinity, have been used toquantify exposure levels around the 10 865 inhabitable building of Besançon. Obtained results show a significantimpact of the neighborhood definition on the exposure levels. Different neighborhood definitions lead to a differentialbias caused by a different accounting for environmental variables. This bias exists for all studied pollutant, but indifferent proportion depending on the pollutant. In a second time, situations of multi-exposure to noise and NO2 havebeen identified in the city. Results indicate a complex relation between pollutants and allow the description of severalmulti-exposure situations across the city. This work constitute one of the firsts approaches of this kind in France andallow a better understanding of the existing relations between neighborhood, exposure area, environmental parametersand exposure levels.