Objetivo: A pesquisa teve como objetivo verificar como as condições atmosféricas intraurbanas atuam no agravamento dos problemas respiratórios, em crianças menores de cinco anos, e, circulatórias e respiratórias, em adultos com mais de sessenta anos, no setor Sul/Sudeste, da cidade de São Paulo, a partir da associação com as variáveis atmosféricas e o índice bioclimático PET (Physiological Equivalent Temperature). Métodos: Analisou-se 12.269 casos de internação por doenças respiratórias em crianças; 24.318 por doenças do aparelho circulatório e 8.894 do aparelho respiratório em idosos. Os dados foram agrupados segundo perfil socioambiental. Nas estações meteorológicas do IAG/USP e do aeroporto de Congonhas foram obtidas variáveis e obteve-se o índice de qualidade do ar na CETESB/CONGONHAS. Foram utilizados: análise estatística descritiva; modelo linear generalizado com distribuição binomial negativa (GLM); e modelo de regressão. Resultados: Houve associação estatística entre as variáveis atmosféricas ambientais e as internações hospitalares, porém de forma diferenciada e específica. O GLM apontou aumento nas internações hospitalares com a elevação em 1ºC de amplitude térmica (0,6por cento) índice de poluição (0,2por cento) e com diminuição na temperatura média (0,9por cento). A regressão apontou aumento de internações com a diminuição das temperaturas médias e mínimas e o índice PET indicou que o calor é protetor. A chance de ocorrência de internações foi 12por cento maior com a diminuição de 1ºC no índice PET e com aumento 1ºC na temperatura máxima, no grupo de pior perfil socioambiental. Doenças Respiratórias em Idosos: O GLM indicou aumento das internações hospitalares com a elevação em 1ºC na amplitude térmica (2,1por cento) e poluição (0,2por cento) e diminuição em 1ºC do PET (1por cento). A regressão aponta maior risco com o aumento da amplitude térmica. Dias com maior taxa de internação foi 3,4por cento maior nos distritos com perfil socioambiental intermediário, com o decréscimo de 1ºC na temperatura mínima. Crianças: O GLM apontou aumento das internações hospitalares com o aumento em 1ºC da temperatura média (3,7por cento), da amplitude térmica (2,7por cento) e da poluição (0,2por cento) e diminuição em 1ºC do índice PET (1por cento). A regressão apontou risco nas faixas intermediárias de temperatura média, de menor temperatura mínima e de maior amplitude térmica. A faixa de conforto térmico mostrou que nas faixas de pouco calor (>31ºC) e frio (<12ºC) há proteção e maior risco na faixa de pouco frio (<18ºC). Houve associação estatística significante nos grupos de diferente perfil socioambiental, de forma homogênea. Conclusões: Houve associação entre a morbidade e as variáveis climáticas e o índice de conforto de forma diferenciada nos grupos etários e de doenças. O desconforto para frio e a alta amplitude térmica consistiram em fatores mais agravantes para o desencadeamento das doenças. Os resultados corroboram parcialmente a hipótese de que os distritos com piores condições socioambientais apresentam maior impacto negativos à saúde. Os dados confirmam a proposição no que se refere ao grupo de adultos com mais de sessenta anos, mas não apresentaram diferenças significativas para o grupo de crianças com doenças respiratórias e menores de cinco anos / Objective: The research aimed to verify how the local climatic conditions can intensify the respiratory disease in children under five years, and circulatory and respiratory in adults sixty years and older. The sector south/southeast of São Paulo city from the association with the atmospheric variables and bioclimatic index PET (Physiological Equivalent Temperature). Methods: 12.269 cases respiratory diseases in children, 24 318 circulatory diseases and 8.894 respiratory tract in elderly people were selected. Admissions data were grouped according to socio-environmental profile. Meteorological variables were obtained at IAG/USP and Congonhas airport stations. Air quality data were obtained in Cetesb station. Statistical and numerical modeling tools were used. Statistical correlation between atmospheric variables and hospital admissions was observed, but in different ways. Results: Circulatory (>60 years old): GLM showed increase in hospital admissions with elevation in 1ºC temperature range (0.6per cent) index of pollution (0.2per cent) and decrease in average temperature (0.9per cent). The occurrence of hospitalizations was 12per cent higher with the decrease 1ºC in PET and increase in 1ºC maximum temperature, to lower socio-environmental profile. Respiratory Diseases (>60): GLM indicated increased hospitalizations with the increase in 1ºC in a temperature range (2.1per cent) and pollution (0.2per cent) and decreased 1ºC PET (1per cent). Higher admissions days (3.4per cent) occurred in districts with middle socio-environmental profile with decrease 1ºC minimum temperature. Children: GLM showed an increase in hospital admissions with an increase in average temperature 1°C (3.7per cent), the temperature range (2.7per cent) and pollution (0.2per cent) and a decrease 1ºC of PET (1per cent). Groups of different socio-environmental was significantly associated with thermal comfort index and temperatures range. Conclusions: There were association between morbidity and climatic variables and comfort index in the age groups and diseases. The results partially support the hypothesis that the districts with the worst social and environmental conditions have a higher negative impact on health. The data confirm the proposition with regard to the group of adults over sixty years, but no significant differences for the group of children with respiratory diseases and under-fives

During the middle decades of the twentieth century, Puerto Rico was transformed from an agrarian, mostly rural, and marginal U.S. colony into an industrialized, urbanized, and politically reorganized territory. For local administrators and public health experts, this transition necessitated confronting widespread mortality from infectious diseases and malnutrition as well as curbing population growth. This dissertation investigates the creation of knowledge about nutrition in Puerto Rico and its incorporation into political and public health practices during this transformative period. For this, it explores how nutrition sciences served to articulate debates about rural poverty and labor as well as how these notions informed distinct public health, welfare, and development interventions. It also analyzes the interaction between this activity on the island and global scientific debates and how local political economy and geopolitical priorities shaped approaches to the nutrition issue. This dissertation first examines how nutrition became a public health concern during the interwar years through the work of biochemists, home economists, agronomists, and social workers. It then explores how these experts incorporated their assessments as part of rural hygiene programs during the Depression and of food policies during World War II. Finally, it analyzes the role of nutrition sciences in the implementation of child feeding programs, food enrichment regulations, dietary supplementation projects, and consumer education campaigns during the postwar years. It also traces the deployment of Puerto Rican nutrition experts as part of international public health and development programs. Throughout these decades, scientific innovations, conceptualizations of poverty, anxieties about overpopulation, and political economy priorities interacted in the articulation of nutrition ideas and their policy implications. By analyzing these dynamics, the dissertation illustrates how nutrition expertise traveled and was reconfigured across scientific, governmental, and political spaces. During the 1930s and 1940s nutrition, agriculture, and public health experts advocated for a reconnection between the island’s food supply and local agricultural production as the fundamental strategy to improve Puerto Ricans’ diets and reform rural society. By the postwar years, these plans to promote agricultural diversification and greater food self-sufficiency became increasingly incongruous with the structural shifts provoked by the new development strategy of industrialization and modernization. Food technologies and innovations provided instruments for health policy makers to gradually adapt their agendas to these changes while recasting nutrition problems as technical issues to be fixed through the dissemination of new products, standards, and infrastructures. The dissertation emphasizes the multiple geographical, disciplinary, and institutional exchanges that shaped how nutrition knowledge was conceived, translated, and generalized in health policy and political debates on the island. To do this, it draws upon archival evidence from government, philanthropic, and academic institutions at local, federal, and international settings. With this framework, the dissertation aims to situate Puerto Rico’s case within international health historiography by focusing on how the local emergence and circulation of nutrition ideas and practices related to global networks of medical and public health expertise. It also aims to contribute to the historiography of development and decolonization and the history of science and technology. Instead of explaining science and public health in Puerto Rico as the “good” effects of United States colonialism or as the transplantation of its biomedical traditions and technologies, this dissertation explores how the interaction between international, colonial, and local structures of power shaped the creation of nutrition knowledge, its political usages, and policy applications.

The complex interplay between climate change, demographics and socioeconomic conditions is transforming the global environmental health landscape. In the aftermath of recent heat waves around the world, especially the 2003 heat wave in Europe, heat is being recognized as an emerging public health issue worldwide, particularly in urban areas. This work explores the historical and future heat-related mortality in New York City, from the beginning of the 20th until the end of the 21st century. New York City is among the largest cities in the world and has been a thriving metropolis over the entire period covered by this study. The unique makeup of the city makes it particularly suitable for studying the impacts of heat over an extended period of time. The presented work encompasses multiple domains of knowledge and illustrates the necessity for applying highly interdisciplinary approaches in addressing the emerging challenges of our time. The background chapter provides an overview of methodological approaches and findings from previous studies with direct relevance to the specific aims of this work. Chapter I is focused on characterizing the impacts of heat on daily mortality since 1900. Here, heat effects are presented in a historical context and changes over time are analyzed and discussed. Chapter II provides a comparative assessment of recent historical and heat impacts until 2100 in New York City, Boston and Philadelphia. This analysis illustrates the differences and similarities between heat impacts in New York City and the other two major urban areas in the U.S. Northeast. Chapter III provides a more comprehensive assessment of future heat-related mortality in New York City under a number of adaptation, climate change and demographic scenarios. The concluding chapter presents a summary of findings and recommendations for future research.

The complex interplay between climate change, demographics and socioeconomic conditions is transforming the global environmental health landscape. In the aftermath of recent heat waves around the world, especially the 2003 heat wave in Europe, heat is being recognized as an emerging public health issue worldwide, particularly in urban areas. This work explores the historical and future heat-related mortality in New York City, from the beginning of the 20th until the end of the 21st century. New York City is among the largest cities in the world and has been a thriving metropolis over the entire period covered by this study. The unique makeup of the city makes it particularly suitable for studying the impacts of heat over an extended period of time. The presented work encompasses multiple domains of knowledge and illustrates the necessity for applying highly interdisciplinary approaches in addressing the emerging challenges of our time. The background chapter provides an overview of methodological approaches and findings from previous studies with direct relevance to the specific aims of this work. Chapter I is focused on characterizing the impacts of heat on daily mortality since 1900. Here, heat effects are presented in a historical context and changes over time are analyzed and discussed. Chapter II provides a comparative assessment of recent historical and heat impacts until 2100 in New York City, Boston and Philadelphia. This analysis illustrates the differences and similarities between heat impacts in New York City and the other two major urban areas in the U.S. Northeast. Chapter III provides a more comprehensive assessment of future heat-related mortality in New York City under a number of adaptation, climate change and demographic scenarios. The concluding chapter presents a summary of findings and recommendations for future research.

Objetivo: A pesquisa teve como objetivo verificar como as condições atmosféricas intraurbanas atuam no agravamento dos problemas respiratórios, em crianças menores de cinco anos, e, circulatórias e respiratórias, em adultos com mais de sessenta anos, no setor Sul/Sudeste, da cidade de São Paulo, a partir da associação com as variáveis atmosféricas e o índice bioclimático PET (Physiological Equivalent Temperature). Métodos: Analisou-se 12.269 casos de internação por doenças respiratórias em crianças; 24.318 por doenças do aparelho circulatório e 8.894 do aparelho respiratório em idosos. Os dados foram agrupados segundo perfil socioambiental. Nas estações meteorológicas do IAG/USP e do aeroporto de Congonhas foram obtidas variáveis e obteve-se o índice de qualidade do ar na CETESB/CONGONHAS. Foram utilizados: análise estatística descritiva; modelo linear generalizado com distribuição binomial negativa (GLM); e modelo de regressão. Resultados: Houve associação estatística entre as variáveis atmosféricas ambientais e as internações hospitalares, porém de forma diferenciada e específica. O GLM apontou aumento nas internações hospitalares com a elevação em 1ºC de amplitude térmica (0,6por cento) índice de poluição (0,2por cento) e com diminuição na temperatura média (0,9por cento). A regressão apontou aumento de internações com a diminuição das temperaturas médias e mínimas e o índice PET indicou que o calor é protetor. A chance de ocorrência de internações foi 12por cento maior com a diminuição de 1ºC no índice PET e com aumento 1ºC na temperatura máxima, no grupo de pior perfil socioambiental. Doenças Respiratórias em Idosos: O GLM indicou aumento das internações hospitalares com a elevação em 1ºC na amplitude térmica (2,1por cento) e poluição (0,2por cento) e diminuição em 1ºC do PET (1por cento). A regressão aponta maior risco com o aumento da amplitude térmica. Dias com maior taxa de internação foi 3,4por cento maior nos distritos com perfil socioambiental intermediário, com o decréscimo de 1ºC na temperatura mínima. Crianças: O GLM apontou aumento das internações hospitalares com o aumento em 1ºC da temperatura média (3,7por cento), da amplitude térmica (2,7por cento) e da poluição (0,2por cento) e diminuição em 1ºC do índice PET (1por cento). A regressão apontou risco nas faixas intermediárias de temperatura média, de menor temperatura mínima e de maior amplitude térmica. A faixa de conforto térmico mostrou que nas faixas de pouco calor (>31ºC) e frio (<12ºC) há proteção e maior risco na faixa de pouco frio (<18ºC). Houve associação estatística significante nos grupos de diferente perfil socioambiental, de forma homogênea. Conclusões: Houve associação entre a morbidade e as variáveis climáticas e o índice de conforto de forma diferenciada nos grupos etários e de doenças. O desconforto para frio e a alta amplitude térmica consistiram em fatores mais agravantes para o desencadeamento das doenças. Os resultados corroboram parcialmente a hipótese de que os distritos com piores condições socioambientais apresentam maior impacto negativos à saúde. Os dados confirmam a proposição no que se refere ao grupo de adultos com mais de sessenta anos, mas não apresentaram diferenças significativas para o grupo de crianças com doenças respiratórias e menores de cinco anos / Objective: The research aimed to verify how the local climatic conditions can intensify the respiratory disease in children under five years, and circulatory and respiratory in adults sixty years and older. The sector south/southeast of São Paulo city from the association with the atmospheric variables and bioclimatic index PET (Physiological Equivalent Temperature). Methods: 12.269 cases respiratory diseases in children, 24 318 circulatory diseases and 8.894 respiratory tract in elderly people were selected. Admissions data were grouped according to socio-environmental profile. Meteorological variables were obtained at IAG/USP and Congonhas airport stations. Air quality data were obtained in Cetesb station. Statistical and numerical modeling tools were used. Statistical correlation between atmospheric variables and hospital admissions was observed, but in different ways. Results: Circulatory (>60 years old): GLM showed increase in hospital admissions with elevation in 1ºC temperature range (0.6per cent) index of pollution (0.2per cent) and decrease in average temperature (0.9per cent). The occurrence of hospitalizations was 12per cent higher with the decrease 1ºC in PET and increase in 1ºC maximum temperature, to lower socio-environmental profile. Respiratory Diseases (>60): GLM indicated increased hospitalizations with the increase in 1ºC in a temperature range (2.1per cent) and pollution (0.2per cent) and decreased 1ºC PET (1per cent). Higher admissions days (3.4per cent) occurred in districts with middle socio-environmental profile with decrease 1ºC minimum temperature. Children: GLM showed an increase in hospital admissions with an increase in average temperature 1°C (3.7per cent), the temperature range (2.7per cent) and pollution (0.2per cent) and a decrease 1ºC of PET (1per cent). Groups of different socio-environmental was significantly associated with thermal comfort index and temperatures range. Conclusions: There were association between morbidity and climatic variables and comfort index in the age groups and diseases. The results partially support the hypothesis that the districts with the worst social and environmental conditions have a higher negative impact on health. The data confirm the proposition with regard to the group of adults over sixty years, but no significant differences for the group of children with respiratory diseases and under-fives

Thesis (D.P.H.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed on Feb. 19, 2010). Includes bibliographical references (p. [197]-216).

The results of this study indicate that two groups of mothers share a relatively similar socioeconomic status, knowledge of health and hygiene, and have similar health-seeking behaviors. The mothers' lack of knowledge and their local view of illnesses seemed to embody questionable newborn care related to breastfeeding practices and oil applications to newborns. Three psychosocial factors that appeared to contribute to the mother's health-seeking behaviors were attitudinal factors (this consisted of favorable or unfavorable perceptions toward services based on the mother's prior experiences or familiarity with service), social pressures (opinions from others and the mother's competing responsibilities), and self-efficacies accessibility, availability, and affordability). In addition, the external factor of poverty in the slum settlements was also a significant factor which determined the mother's health seeking behaviors. The implications of these findings are discussed in further detail, which are then followed by a set of recommendations for future health interventions designed to reduce the risk of sepsis neonatorum in urban communities. This study underscores the benefits of integrating the perspectives of anthropology and public health to further the understanding of the neonatal health problem. Finally, the need for future studies is addressed as it is necessary to further understand the existing local practices and beliefs in relation to the risks of sepsis neonatorum.

Background: Most countries of sub-Saharan Africa (SSA) are experiencing a high rate of ur­banization accompanied with unplanned development resulting into sprawl of slums. The weath­er patterns and air pollution sources in most urban areas are changing with significant effects on health. Studies have established a link between environmental exposures, such as weather variation and air pollution, and adverse health outcomes. However, little is known about this relationship in urban populations of SSA where more than half the population reside in slums, or slum like conditions. A major reason for this is the lack of systematic collection of data on exposure and health outcomes. High quality prospective data collection and census registers still remain a great challenge. However, within small and spatially defined areas, dynamic cohorts have been established with continuous monitoring of health outcomes. Collection of environmental exposure data can complement cohort studies to investigate health effects in relation to environmental exposures. The objective of this research was to study the health effects of selected environmental exposure among the urban poor population in Nairobi, Kenya. Methods: We used the platform of the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), including two nested research studies, to provide data on mortality and mor­bidity. The NUHDSS was established in two areas of Nairobi, Korogocho and Viwandani, in 2003 and provides a unique opportunity for access to longitudinal population data. In addition, we conducted real-time measurements of particulate matter (PM2.5) in the areas from February to October in 2013. We obtained meteorological measurements from the Moi Air Base and Nairobi airport weather stations for the study period. We also conducted a cross-sectional survey to estab­lish the communities’ perceptions about air pollution and its related health risks. Time series re­gression models with a distributed lag approach were used to model the relationship between weather and mortality. A semi-ecological study with group level exposure assignment to individuals was used to assess the relationship between child health (morbidity and mortality) and the extent of PM2.5 exposure. Results: There was a significant association between daily mean temperature and all-cause mor­tality with minimum mortality temperature (MMT) in the range of 18 to 20 °C. Both mortality risk and years of life lost analysis showed risk increases in relation to cold temperatures, with pronounced effect among children under-five. Overall, mortality risks were found to be high during cold periods of the year, rising with lower temperature from MMT to about 40% in the 0–4 age group, and by about v 20% among all ages. The results from air pollution assessment showed high levels of PM2.5 concentration exceeding World Health Organization (WHO) guideline limits in the two study ar­eas. The air pollution concentration showed similar seasonal and diurnal variation in the two slums. The majority of community residents reported to be exposed to air pollution at work, with 66% reporting to be exposed to different sources of air pollution. Despite the observed high level of exposure, residents had poor perception of air pollution levels and associated health risks. Children in the high-pollution areas (PM2.5≥ 25 μg⁄m3) were at significantly higher risk for morbidity (OR = 1.30, 95% CI: 1.13-1.48) and cough as the only form of morbidity (OR = 1.33, 95% CI: 1.15-1.53) compared to those in low-pollution areas. In addition, exposure to high levels of pollution was associated with high child mortality from all-causes (IRR=1.15, 95% CI: 1.03-1.28), and indicated a positive association to respiratory related mortality (IRR=1.10, 95% CI: 0.91-1.33). Conclusion: The study findings extend our knowledge on health impacts related to environmental exposure by providing novel evidence on the risks in disadvantaged urban populations in Af­rica. More specifically, the study illustrates the invisible health burden that the urban poor population are facing in relation to weather and air pollution exposures. The effect of cold on population is preventable. This is manifested by the effective adaptation to cold conditions in high-latitude Nordic countries by housing standards and clothing, as well as a well-functioning health system. Further, awareness and knowledge of consequences, and reductions in exposure to air pollution, are necessary to improve public health in the slum areas. In conclusion, adverse health impacts caused by environmental stressors are critical to assess further in disadvantaged populations, and should be followed by development of mitigation measures leading to improved health and well being in SSA.

Diss. (sammanfattning) Umeå : Univ., 2008. / Härtill 4 uppsatser.

Thesis (Ph.D.)--Brown University, 2004. / Vita. Includes bibliographical references (leaves 240-257).