Desastre da Mineração em Maceió-AL: Avaliando o Impacto na Saúde dos Atingidos

Objective: Perform a systematic review of systemic arterial hypertension (SAH) diagnosis and follow-up using home blood pressure monitoring (HBPM) and report the experience of using an online tool (TeleMRPAÔ) for results report in Brazil. Design and method: The MedlineÔ, EmbaseÔ, and Cochrane LibraryÔ databases were searched for randomized studies on the effectiveness of the monitoring and diagnosis of SAH with HBPM from 2014 to 2018. The keywords used were hypertension, blood pressure, home blood pressure monitoring. A full review of 132 articles was performed and 36 studies were considered potentially eligible. Out of the 36 potentially eligible studies, 25 studies were published from 2014 to 2018, conducted in North America and Europe and included a wide variety of hypertension assessment methods. Only 10 studies aimed to analyze HBPM as a tool for the diagnosis and / or follow-up of SAH. TeleMRPAâ is an online tool (www.telemrpa.com) developed in Brazil to facilitate HBPM results reporting by cardiologists. Through this tool, it is possible to standardize the report and, from the data entered online, it is possible to generate a final report that gives greater feasibility, reproducibility of the method, minimizing errors. Results: The regular use of HBPM decreases the rates of cardiovascular events and SAH related mortality, as well as lower health care costs when compared to the monitoring of SAH only with office measurements. There was a consonance of the studies indicating a low sensitivity of the blood pressure measurement in the office to detect the optimal control of SAH when compared to the addition of HBPM. Thus, TeleMRPAâ made it possible for HBPM to be extended to more cardiologists and their patients. Conclusions: The use of HBPM showed to be effective. The HBPM should be included in the diagnosis and follow-up of SAH more routinely. Still, HBPM encourages the increase of patient participation in their self-care, as it reinforces patient-centered care, improving SAH control. In addition, in Brazil, the TeleMRPAâ has made SAH monitoring more comprehensive.

Objectives: Analyze the evolution presented by patients hospitalized with the moderate or severe form of COVID-19, know the sociodemographic profile, the comorbidities presented by this sample and verify the complete data of the records found in the medical records. Materials and Methods: A retrospective, analytical and descriptive study was carried out on a sample consisting of 934 patients admitted in the period 2020/21, at the Hospital de Clínicas of the Federal University of UberlândiaHCUFU. Patients over 18 years of age with a confirmed clinical and laboratory diagnosis of COVID-19 at the time of admission were included, whose medical records could be accessed. The various variables were statistically analyzed using the X2 Test and the Odds Ratio calculation, comparing patients who were discharged from hospital and those who died. Results: In the sample analyzed, 137 patients died (14.66%). When comparing the groups (survivors -hypertensives, diuretics, oral hypoglycemic drugs, hormonal therapy, corticosteroids, drop in hemoglobin saturation, cough, fever, fatigue, anorexia, nausea, anosmia, dysgeusia, vomiting and diagnosis of pneumonia. The predictive variables for lower hospital mortality were: being white, having a diagnosis of systemic arterial hypertension, using oral hypoglycemic medication and having a cough and fever. The greater chance of death was related to older age, being male, having reduced hemoglobin saturation, reporting myalgia and having a diagnosis of pneumonia. Flaws were found in the medical records characterized by the lack of records related to the patients' past history, the treatment instituted and the complications presented. The statistical test (X2) showed a difference in the comparison between the two groups regarding length of stay, age, male sex, diagnosis of systemic arterial hypertension, obesity, autoimmune disease, kidney disease, stroke, chronic obstructive pulmonary disease, use of antihypertensives, diuretics, oral hypoglycemic agents, hormonal therapy, corticosteroids, drop in hemoglobin saturation, cough, fever, fatigue, anorexia, nausea, anosmia, dysgeusia, vomiting and diagnosis of pneumonia. Conclusions: The study revealed the clinical course of patients with COVID-19 in serious condition, from admission to the tragic outcome of death. This information can be crucial in formulating public health strategies for targeted screening and effective control of modifiable risk factors, such as smoking, hypertension, and diabetes, with the aim of reducing both the morbidity and mortality associated with the disease.

Operationalising planetary health as a game-changing paradigm: health impact assessments are key

Free Papers Compiled

Objective: Aortic pulse wave velocity (PWV) is a well-established marker of arterial stiffness (AS) and is an independent predictor of cardiovascular risk. However, to which extent this hemodynamic parameter could be used for the diagnosis of systemic arterial hypertension (AH) has not been consistently addressed, and this was the objective of our study. Design and method: A cross-sectional study including 54 consecutive apparently healthy adults, with elevated office blood pressure (BP) (new AH), free of any chronic medication or relevant clinical condition. Carotid-femoral PWV was measured to all participants with the Complior SP device, complying with the methodological recommendations, and 24 h ambulatory blood pressure monitoring (ABPM) was used to confirm the presence of AH. All participants were evaluated by the same experienced clinician. Results: The 54 participants had a mean age of 46 ± 11 years, was predominantly male (n = 48; 89%), with a mean body mass index of 27 ± 4 Kg/m2, mean office BP was 163 ± 13 mmHg for systolic BP and 95 ± 9 mmHg for diastolic BP, and mean heart rate of 75 ± 12 bpm. Mean total cholesterol was 184 ± 35 mg/dL, HDL-cholesterol was 53 ± 11 mg/dL and glycaemia was 86 ± 11 mg/dL. PWV was significantly correlated with age, BP and potassium levels. Abnormal ABPM was identified in 44 participants (86%). The predictive capacity of PWV for the diagnosis of new HT was checked in a ROC-curve analysis (figure), from which an AUC of 0.76 (IC: 0.61–0.92; p = .02) was observed. A cut-off of 9.5 m/s had a sensibility of 94%, with a positive predictive value of 90% for an abnormal ABPM and confirmation of HT.Conclusions: This study provides promising preliminary results on the potential use of PWV for clinical decision-making concerning the diagnosis of new AH in adults, with PWV expressing predominant hemodynamic changes that are predictive for the presence of HT in adults with a first abnormal office BP measurement.

BackgroundReducing the mortality burden associated with urban air pollution constitutes a public health priority, and evidence of unequal exposure and susceptibility across population subgroups is growing. Many European countries have implemented low emission zones (LEZs) in densely populated city centers. Although LEZs decrease air pollution exposure and health impacts, evidence is lacking on their impact across neighborhoods and socio-economic groups.ObjectivesThe aim of this study was to evaluate the most equitable approach to implementing the second phase of the LEZ in Paris, France. We also present a literature review of the studies evaluating the benefits associated with LEZs in Europe.MethodsA health impact assessment (HIA) was conducted to quantify changes in air pollution exposure and expected health benefits by socioeconomic group and neighborhood related to four hypothetical scenarios for the second phase of the LEZ based on French Deprivation Index scores. The study focused on NO2 and PM2.5 as air pollutants and evaluated the impact of the LEZ on the inequitable burden of childhood asthma and all-cause premature adult mortality. We also conducted an economic evaluation associated with the LEZ benefits on prevented deaths and asthma cases.ResultsThe scenario with the largest LEZ perimeter and the most stringent vehicle standards prevented the highest number of cases and produced the most equitable distribution of health benefits, especially childhood asthma. It is expected that 810 deaths and 3200 cases of asthma could be prevented from the LEZ extension in this scenario. These results were distributed heterogeneously across three socioeconomic (SES) groups, most noticeably with asthma cases as 230, 180, and 210 cases were avoided per 100,000 inhabitants in high, medium, and low SES groups, respectively. We found substantial economic benefits associated with LEZ, with estimates ranging from €0.76 billion to €2.36 billion for prevented deaths. The benefits associated with asthma reduction ranged from €2.3 million to €8.3 million.DiscussionConducting HIAs with a focus on equity will further inform policy makers of the impact of LEZ models on air pollution, health, and environmental justice. Developing these systematic methods and applying them to future LEZs and other air pollution policies will increase their effectiveness to reduce the burden of ambient air pollution on society and the environment.

Background: Introduction of health impact assessment (HIA) as a national legal requirement for planned economic activity projects in 2002 and the further development of related procedures and methodological requirements has boosted the number of HIAs carried out both as an integrated part of environmental impact assessment (EIA) procedures as well as an independent activity. Most of HIAs have been conduct for local projects. The HIA for the reconstruction of the southern section of the railroads in Klaip da National Seaport is one of the local HIAs in Lithuania carried out as an independent procedure. Methods: The HIA for the reconstruction of the southern section of the railroads in Klaipda National Seaport was carried out following the national legal procedure for the cases not foreseen in the Law on Environmental Impact Assessment of Planned Economic Activity and the national HIA methodological regulations. The HIA included a literature review, analysis of related technical documentation, data on existing and estimated air pollution and environmental noise levels and possible health consequences, analysis of local demographic and health statistics; interviews with the residents living in proximity of the planned activity, analysis of public complaints on existing activities at Klaip da National Seaport, site visit and round table discussions with the proponent of the planned activity, planning company and representatives of the public health authority. The standard or intermediate type of perspective HIA was applied. Results: The HIA report has pointed out noise, vibration, ambient air pollution, psychological factors as related to possible negative impact on health of residents living in the mostly exposed locations. Interviews with inhabitants living in proximity of the planned activity have shown that majority of them knew nothing about the reconstruction plans. Recommendations were provided in the report how to minimise existing and prevent newly emerging negative health impacts from the planned economic development related to ambient air and environmental noise pollution as well as recommendations for communication improvement. with the residents. Conclusion: The HIA provided the proponent of planned activity, as well as the regional public health authority and the concerned public with relevant information on the main health determinants and possible health impacts of the planned reconstruction of the railway segment. HIA recommendations stimulated the proponent to agree on additional measures reducing negative health impact of the planned activity. This case of HIA also revealed some strengths and weaknesses of the overall HIA framework in Lithuania.

A10 Use of Health Impact Assessment to Promote Safe Built Environments for Active Transportation

Objectives This project aimed to introduce Health Impact Assessment (HIA) into urban redevelopment planning in Japan to promote health-conscious urban environments and support wider HIA implementation. We applied HIA to the "University of Tokyo Nishi-Chiba Campus Redevelopment Project" in Chiba City, Japan, to examine potential effects on residents' health and well-being.Methods Among the three HIA types (comprehensive, rapid, and desktop), we selected the rapid HIA because of time limitations. The project carried out the initial four HIA steps: screening, scoping, appraisal, and reporting, excluding monitoring. We developed an HIA assessment matrix tailored to Japanese urban development by adapting the "HIA Screening Tool" of the Japanese Society of Public Health and consulting international HIA resources. Using this matrix, we organized three workshops that included local government officials, developers, and academic experts. The workshops evaluated potential health impacts of the redevelopment from multiple stakeholder perspectives.Results Each indicator in the matrix was examined, and consensus on judgments was reached during the workshops. Based on these judgments, we identified necessary improvements and formulated recommendations. Pre-development recommendations included creating a green-space map with resident involvement, enhancing information sharing with nearby medical facilities, and implementing transportation and mobility measures. Post-development recommendations included establishing an area-management organization, hosting community events to support interaction between existing and incoming residents, and strengthening collaboration with local businesses. Our research group compiled these recommendations into a final report and provided it to the developers and the local government.Conclusion This HIA project enabled a systematic evaluation of the health impacts of an urban redevelopment initiative and generated actionable recommendations. Workshops involving diverse stakeholders improved the credibility and practical value of the assessment. Nevertheless, challenges remain, including limited public participation, a compressed schedule, and constrained influence on major design elements because HIA was introduced at an advanced project stage. We expect that the "HIA Checklist for Urban Planning in Japan" developed through this study will be incorporated into future redevelopment efforts and contribute to the broader adoption of HIA and the advancement of healthier urban environments in Japan.

Health impact assessment in Latin American countries: Current practice and prospects

Many countries conduct Health Impact Assessment (HIA) of their projects and policies to predict their positive and negative health impacts. In recent years many guides have been developed to inform HIA practice, largely reflecting local developments in HIA. These guides have often been designed for specific contexts and specific need, making the choice between guides difficult. The objective of the current study is to identify underlying principles in order to guide HIA practice in Iran. This study was conducted in three stages: 1) Studies comparing HIA guidelines were reviewed to identify criteria used for comparison seeking emphasized principles. 2) The HIA characteristics extracted from published papers were categorized in order to determine the principles that could guide HIA practice. 3) Finally, these principles were agreed by experts using nominal group technique. The review of the studies comparing HIA guides demonstrated there are no clear comparison criteria for reviewing HIA guides and no study mentioned HIA principles. Investigating the HIA principles from peer-reviewed papers, we found 14 issues. These were, considering of general features in planning and conducting HIAs such as HIA stream, level, timing and type, considering of the wider socio-political and economic context, considering of economic, technical and legal aspects of HIA and capacities for HIA, rationality and comprehensiveness, using appropriate evidence, elaborating on HIA relation to other forms of Impact Assessment, considering of equity, and encouraging intersectoral and interdisciplinary cooperation, involvement of stakeholders and transparency as underlying principles to guide HIA practice. The results emphasize how critical these technical as well as tactical considerations are in the early scoping step of an HIA which plans the conduct of the HIA in reponse to local contextual issues. Determining the principles of HIA from peer-reviewed papers provides an opportunity for guiding HIA practice comprehensively. It seems to be feasible to develop a universal guide that covers all principles required.

Impact assessment is commonly presented as a central pillar of evidence-based policy-making and the solution to making ‘better’ regulation. It has also been identified as a mechanism by which the Health in All Policies (HiAP) agenda might be advanced, ensuring that the health impacts of all interventions - whether originating in the health sector or not - are taken into account by policymakers. Yet, it remains difficult to identify, quantify and balance health impacts, to integrate qualitative and longer-term health costs and benefits into analysis, and ensure that the findings and nuances of impact assessment are considered within the policy process. Moreover, challenging current political developments may reduce input legitimacy and increase corporate capture of the impact assessment process, as seen in cases such as the tobacco industry. EUPHA has a well-established programme of work in this space, critiquing and advancing the practice of impact assessment in the public health field. Drawing on this expertise and adding value by combining it, this workshop brings together representatives from the Public Health Politics and Policy (PHPP), Health Impact Assessment (HIA) and Public Health Economics (PHE) sections of EUPHA. A panel of experts will examine the role of impact assessment in health policy and address a core challenge to it; namely, the capacity for impact assessment to make the policy process more amenable to public health concerns. Presentations (using the 15x15 format) will introduce the European Commission's approach to (health) impact assessment (Orhan Pees), explore existing methodologies of HIA and the challenges that they face (Martin), critique the applicability of dominant pharmacoeconomics approaches to assessment of public health interventions (Vasco Santos), examine the relevance of health system performance assessment to impact assessment exercises (Blümel et al.). Each panellist will be asked to close their presentation by addressing the following question: to what extent is impact assessment a valuable tool for delivering policy that is good for health?Key messages• Impact assessment has advanced significantly in recent years, but its ability to deliver better policy outcomes for health requires continual, multidisciplinary appraisal.• Sound evaluation of health impact requires clinical, economic and political expertise, an interface which EUPHA is uniquely situated to promote.Speakers/PanellistsRana Orhan PeesEcorys, Rotterdam, NetherlandsPiedad Martin-OlmedoEscuela Andaluza de Salud Pública, Granada, SpainJoão Vasco SantosUniversity of Porto / CINTESIS / ARS Norte, Porto, PortugalMiriam BlümelBerlin University of Technology, Berlin, Germany

Background: Health impact assessments (HIAs) are used to systematically analyze the potential health impacts of proposed policies and provide recommendations that promote positive impacts and mitigate adverse impacts. This study reviewed HIAs conducted in the United States, England, and New Zealand on policies related to alcohol, tobacco, and marijuana Methods: Information was abstracted from relevant HIAs identified from multiple web sources using a set of predetermined criteria and key data elements. Four case studies were selected to highlight methods and impacts for conducting HIAs Results: Twenty-two HIAs from U.S., England, and New Zealand conducted from 2005-2019 were retained for the final analysis. Policies assessed included zoning laws and density for alcohol and tobacco outlets, raising legal tobacco purchasing age to 21, prevention of underage drinking, and marijuana regulations. These HIAs used methods such as literature review, local data, and stakeholder interviews to characterize the direction, magnitude, intensity, likelihood, and distribution of potential health effects. Stakeholder input was obtained on how to mitigate negative and promote positive health effects that could result from the proposed policy. The HIA results were provided to decision-makers to encourage them to consider health impacts in the decision process. Conclusion: HIAs are a promising tool for policymakers and stakeholders to assess the potential health impacts of proposed alcohol, tobacco, and marijuana policies. Our review is consistent with prior reports from other sectors suggesting that HIAs may increase awareness of health impacts among decision-makers, improve collaboration among stakeholders, and have direct impacts on policy decisions.

SCOPEWhile there is a growing body of literature on how to conduct health impact assessments (HIAs) most of the guidance to date focuses on how to conduct health baselines and identify potential impacts. Little information is reported on how to more effectively use assessment results to make practical business decisions at the site level that will help to safeguard community health and manage project risk.METHODThe opinion of interdisciplinary HIA practitioners in the oil and gas and extractive sectors were surveyed with the intent of taking the pulse of the HIA community as to the perceived current challenges and opportunities for HIA results to contribute to informing business decisions, managing business decisions, and safeguarding the health of communities within the zone of influence.RESULTSOverall, survey respondents had a favorable perspective on the state of HIA based on the surveyed categories. Over half of respondents indicated they perceived HIAs were moving from impact assessment to decision making and management, specifically: 1) HIA mitigations are included in site-wide management plans, 2) HIA mitigations are effective, 3) HIA mitigations were effective at addressing the impact they were meant to manage, and 4) HIA mitigations are responsive to community concerns. Surveyed participants provided potential future steps that might be considered to improve implementation and effectiveness of HIA results at supporting project decision making and managing project risk.NOVEL/ADDITIVE INFORMATIONThis paper represents an initial step to better understand what results private sector HIAs are producing and how these results are being used by the business by presenting an interdisciplinary perspective on the current perceived state of HIA and practical steps to help HIA results become more implementable and effective at supporting project decision making. Thus, supporting a future shift in focus in the field of HIAs from assessment of potentially significant health impacts to improved business decision making and implementation of mitigation solutions to further help safeguard the health of communities and manage project risk.

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