Environmental Health Surveillance Research Articles

Assessment of genotoxicity of air pollution in urban areas using an integrated model of passive biomonitoring

Atmospheric pollution is a major public health issue and has become increasingly critical for human health. Urban atmospheric pollution is typically assessed through physicochemical indicators aligned with environmental legislation parameters, providing data on air quality levels. While the effects of pollution on sensitive organisms serve as a warning for public health decision-makers, there remains a need to explore the interpretation of environmental data on pollutants. The use of species adapted to urban environments as sentinels enables continuous and integrated monitoring of environmental pollution implications on biological systems. In this study, we investigated the use of the plant species Tradescantia pallida as a biomonitor to evaluate the genotoxic effects of atmospheric pollution under diverse vehicular traffic conditions. T. pallida was strategically planted at the leading urban intersections in Uberlândia, Brazil. During COVID-19 pandemic lockdowns, we compared indicators such as physical, biological, and traffic data at different intersections in residential and commercial zones. The reduction in vehicular traffic highlighted the sensitivity of plant species to changes in air and soil pollutants. T. pallida showed bioaccumulation of heavy metals Cd and Cr in monitored areas with higher traffic levels. Additionally, we established a multiple linear regression model to estimate genotoxicity using the micronucleus test, with chromium concentration in the soil (X1) and particulate matter (PM) in the atmosphere (X2) identified as the primary independent variables. Our findings provide a comprehensive portrait of the impact of vehicular traffic changes on PM and offer valuable insights for refining parameters and models of Environmental Health Surveillance.

Development of a novel fluorescent protein-based probe for efficient detection of Pb2+ in serum inspired by the metalloregulatory protein PbrR691

BackgroundThe accurate and rapid detection of blood lead concentration is of paramount importance for assessing human lead exposure levels. Fluorescent protein-based probes, known for their high detection capabilities and low toxicity, are extensively used in analytical sciences. However, there is currently a shortage of such probes designed for ultrasensitive detection of Pb2+, and no reported probes exist for the quantitative detection of Pb2+ in blood samples. This study aims to fill this critical void by developing and evaluating a novel fluorescent protein-based probe that promises accurate and rapid lead quantification in blood. ResultsA simple and small-molecule fluorescent protein-based probe was successfully constructed herein using a peptide PbrBD designed for Pb2+ recognition coupled to a single fluorescent protein, sfGFP. The probe retains a three-coordinate configuration to identify Pb2+ and has a high affinity for it with a Kd’ of 1.48 ± 0.05 × 10−17 M. It effectively transfers the conformational changes of the peptide to the chromophore upon Pb2+ binding, leading to fast fluorescence quenching and a sensitive response to Pb2+. The probe offers a broad dynamic response range of approximately 37-fold and a linear detection range from 0.25 nM to 3500 nM. More importantly, the probe can resist interference of metal ions in living organisms, enabling quantitative analysis of Pb2+ in the picomolar to millimolar range in serum samples with a recovery percentage of 96.64%–108.74 %. SignificanceThis innovative probe, the first to employ a single fluorescent protein-based probe for ultrasensitive and precise analysis of Pb2+ in animal and human serum, heralds a significant advancement in environmental monitoring and public health surveillance. Furthermore, as a genetically encoded fluorescent probe, this probe also holds potential for the in vivo localization and concentration monitoring of Pb2+.

A comprehensive, open-source data model for wastewater-based epidemiology.

The recent SARS-COV-2 pandemic has sparked the adoption of wastewater-based epidemiology (WBE) as a low-cost way to monitor the health of populations. In parallel, the pandemic has encouraged researchers to openly share their data to serve the public better and accelerate science. However, environmental surveillance data are highly dependent on context and are difficult to interpret meaningfully across sites. This paper presents the second iteration of the Public Health Environmental Surveillance Open Data Model (PHES-ODM), an open-source dictionary and set of data tools to enhance the interoperability of environmental surveillance data and enable the storage of contextual (meta)data. The data model describes how to store environmental surveillance program data, metadata about measurements taken on various specimens (water, air, surfaces, sites, populations) and data about measurement protocols. The model provides software tools that support the collection and use of PHES-ODM formatted data, including performing PCR calculations and data validation, recording data into input templates, generating wide tables for analysis, and producing SQL database definitions. Fully open-source and already adopted by institutions in Canada, the European Union, and other countries, the PHES-ODM provides a path forward for creating robust, interoperable, open datasets for environmental public health surveillance for SARS-CoV-2 and beyond.

A-327 Pre-analytical and Analytical Modifications to Improve the Quality of Pediatric Lead Tests

Abstract Background The recent decrease in the CDC Blood Lead Reference Value (BLRV) to 3.5 ug/dL has highlighted the need for systematic changes that some clinicians and laboratories need to implement to assure the quality of reported pediatric lead results. Building upon the recommendations of the Blood Lead Reference Value Workgroup, APHL has developed specific recommendations and resources designed to assist medical professionals and laboratory scientists in minimizing the likelihood of contamination when collecting and testing blood specimens. Also included are analytical practices that can improve precision, accuracy, and sensitivity of pediatric lead assays. Methods Evaluation of existing protocols and practices to identify potential sources of contamination and opportunities for process improvement. Results APHL will provide practical recommendations to systematically improve point of care and fixed laboratory testing to improve confidence in reported pediatric lead concentrations. These improved measurements will improve environmental health surveillance and inform public health intervention and patient care. Conclusion Rigorous pre-analytical practices including education, updated specimen collection guidance, pre-screening of collection materials, improvement of point of care technology and refinement of spectroscopic analytical methods result in less ambient contamination, improved sensitivity, precision and accuracy of pediatric lead testing. Clinician office practices, public health and commercial clinical laboratories will all benefit from implementing these strategies.

The Influence of Environmental Issues on Health Promotion: A Historical Journey and Contemporary Challenges

In this editorial, we address the relationship between environmental issues and health promotion, highlighting how these topics are of great global relevance. Over the past decades, understanding of the complex links between health and the environment has progressed, with solid evidence on the adverse effects of air pollution, water contamination, inadequate waste management, biodiversity loss and climate change on human health. These environmental problems can cause a variety of diseases, including respiratory, cardiovascular, cancer and neurological disorders. Despite scientific advances in the field, challenges are persistent. Air pollution and ecosystem degradation continue to affect people's quality of life, compromising the availability of essential resources such as drinking water and food. Climate change also becomes a growing threat, leading to extreme weather events and the spread of vector-borne diseases. As such, integrated and sustainable approaches that protect both human health and the environment are needed. This requires coordinated action at local, national, and global levels, involving governments, the private sector, civil society, and individuals. It reinforces the need to strengthen environmental health surveillance systems, universalize access to basic sanitation and promote environmental education to raise awareness about the importance of health and the environment. We trace the historical evolution of the relationship between health and the environment, highlighting the influence of ancient thinkers such as Hippocrates, passing through moments of greater and lesser attention to environmental issues in public health. Events such as the Stockholm Conference in 1972, Eco-92 in 1992 and the adoption of the Sustainable Development Goals in 2015 are significant milestones in the promotion of environmental and health policies. Human health and the health of the planet are intrinsically linked, hence the need to rethink the development model and adopt effective measures to achieve global environmental goals, aiming to build a healthier, sustainable, and resilient world for present and future generations.

Serological and molecular investigations on Toxoplasma gondii and Leptospira spp. in bats captured in urban areas from Brazil

Zoonoses affect multiple host species, including bats, which are known to harbor and transmit many zoonotic pathogens. The objective of this study was to detect antibodies against to Toxoplasma gondii and Leptospira spp., as well as DNA of the respective pathogens in bats captured for for rabies diagnosis. Bats at risk, falling or roosting in unusual places, were rescued by the Environmental Health Surveillance in Botucatu, São Paulo, and sent to the Zoonosis Diagnosis Service of the São Paulo State University (UNESP), FMVZ-UNESP, Campus of Botucatu, SP to perform the diagnostic test of rabies. Serum samples from these animals were used tested for the Modified Agglutination Test (MAT-Toxo), the Microscopic Agglutination Test (MAT-Lepto), while blood samples were submitted for conventional PCR. In total, nine species of bats, insectivores, and frugivores (n = 49) of the genera Artibeus, Eptesicus, Eumops, Lasiurus, Molossus, and Myotis. Among the 49 samples tested, MAT-Toxo detected Toxoplasma antibodies in seven (14.2%), while MAT-Lepto detected Leptospira antibodies in 3 (6.1%). None of the samples tested positive by PCR. The results indicate natural exposure of insectivorous bats to T. gondii and Leptospira spp. in urban areas of Brazil and the possibility of these animals acting as reservoirs and disseminating these pathogens in the environment.

Indigenous territories of the Brazilian Amazon facing agribusiness expansion: a pesticide exposure susceptibility index based on Census data

The expansion of the agribusiness sector, mostly fueled by the international demand for agricultural commodities, is strongly associated with increasing pesticide applications. In Brazil, deforestation and land conflicts are also critical issues that have followed the agricultural frontier expansion. In this scenario, indigenous peoples and their territories are often found in a vulnerable position. Their reliance on natural resources, i.e., waterbodies potentially impacted by pesticides, can lead to chronical exposure and health impacts. Therefore, to evaluate the vulnerability of indigenous communities related to pesticide exposure, we developed an index of pesticide exposure susceptibility, based on data provided by the Census of Agriculture 2017, and applied it to the municipalities in the Brazilian Legal Amazon. Selected variables that are directly or indirectly related to the intensity of pesticide application were processed using GIS, generating a map that compiles agricultural areas classified according to the index values along with the limits of indigenous territories, and the hydrographic network for the study area. The final output allowed a clear visualization of the index gradients across the territory and the identification of priority areas for further in situ studies. This represents a useful management tool for indigenous and environmental health surveillance.

A One-Year Retrospective Analysis of Viral and Parasitological Agents in Wildlife Animals Admitted to a First Aid Hospital.

This study aimed to provide information on the presence and frequency of viral and parasitic agents in wildlife presented to a Veterinary Teaching Hospital in 2020-2021. Serum and faecal samples were collected from 50 rescued animals (roe deer, fallow deer, foxes, badgers, pine martens, and porcupines) and examined by serological, molecular, and parasitological techniques. Transtracheal wash (TTW) was also collected post-mortem from roe deer. Overall, the results of the different techniques showed infections with the following viral and parasitic agents: Bovine Viral Diarrhea Virus, Small Ruminant Lentiviruses, Kobuvirus, Astrovirus, Canine Adenovirus 1, Bopivirus, gastrointestinal strongyles, Capillaria, Ancylostomatidae, Toxocara canis, Trichuris vulpis, Hymenolepis, Strongyloides, Eimeria, Isospora, Dictyocaulus, Angiostrongylus vasorum, Crenosoma, Dirofilaria immitis, Neospora caninum, Giardia duodenalis, and Cryptosporidium. Sequencing (Tpi locus) identified G. duodenalis sub-assemblages AI and BIV in one roe deer and one porcupine, respectively. Adult lungworms collected from the TTW were identified as Dictyocaulus capreolus (COX1 gene). This is the first molecular identification of G. duodenalis sub-assemblage AI and D. capreolus in roe deer in Italy. These results show a wide presence of pathogens in wild populations and provide an overview of environmental health surveillance.

Disruption to water supply and waterborne communicable diseases in northeast Syria: a spatiotemporal analysis

BackgroundIn Syria, disruption to water and sanitation systems, together with poor access to vaccination, forced displacement and overcrowding contribute to increases in waterborne diseases (WBDs). The aim of this study is to perform a spatiotemporal analysis to investigate potential associations between interruptions to water, sanitation, and hygiene (WASH) and WBDs in northeast Syria using data collected by the Early Warning Alert and Response Network (EWARN) from Deir-ez-Zor, Raqqa, Hassakeh and parts of Aleppo governorates.MethodsWe reviewed the literature databases of MEDLINE and Google Scholar and the updates of ReliefWeb to obtain information on acute disruptions and attacks against water infrastructure in northeast Syria between January 2015 and June 2021. The EWARN weekly trends of five syndromes representing waterborne diseases were plotted and analysed to identify time trends and the influence of these disruptions. To investigate a potential relationship, the Wilcoxon rank sum test was used to compare districts with and without disruptions. Time series analyses were carried out on major disruptions to analyse their effect on WBD incidence.ResultsThe literature review found several instances where water infrastructure was attacked or disrupted, suggesting that water has been deliberately targeted by both state and non-state actors in northeast Syria throughout the conflict. Over time, there was an overall upwards trend of other acute diarrhoea (OAD, p < 0.001), but downwards trends for acute jaundice syndrome, suspected typhoid fever and acute bloody diarrhoea. For the major disruption of the Alouk water plant, an interrupted time series analysis did not find a strong correlation between the disruption and changes in disease incidence in the weeks following the incident, but long-term increases in WBD were observed.ConclusionsWhile no strong immediate correlation could be established between disruptions to WASH and WBDs in northeast Syria, further research is essential to explore the impact of conflict-associated damage to civil infrastructure including WASH. This is vital though challenging given confounding factors which affect both WASH and WBDs in contexts like northeast Syria. As such, research which includes exploration of mitigation after damage to WASH is essential to improve understanding of impacts on quantity and quality of WASH. More granular research which explores the origin of cases of WBDs and how such communities are affected by challenges to WASH is needed. One step towards research on this, is the implementation of adequate reporting mechanisms for real time tracking of the WASH attacks, damages, direct effects, and likely impact in conjunction with environmental and public health bodies and surveillance systems.

International Network for Public Health and Environmental Tracking (INPHET) and its role to Environmental Epidemiology

Background and aim: INPHET was formed by a community of environmental public health practitioners to address common interests and activities that advance environmental public health surveillance (EPHS) and data systems, and their uses to inform public health actions. Our aim is to show how this has supported environmental epidemiology practice. Methods: A &amp;#x22;Community of Practice”, INPHET main goals focus on sharing experiences and expertise; addressing common challenges to implementation and enhancing the science of EPHS/tracking; improving understanding of the link between the environment and health; and providing the appropriate evidence that informs public policy. Results: The network, initiated in ISEE meetings in 2012-13 and formally launched in Modena, Italy in 2014, has carried out several activities which aim at sharing expertise and learning from different models of environmental and health data integration and surveillance systems that directly inform policy. These include Twinning cooperation with Euro-Asian and Balkan countries and sharing of expertise with African Public Health Agencies. Some experiences are presented in this Symposium (Georgia, Ghana, Zambia), and highlight the EPHS/Tracking (EPHT) model adopted by several national public health agencies. It promotes that such integration and uses of environmental and health data is key for EPHS, including their accessibility and usability for communities of public health researchers, practitioners and policy makers. Conclusions: Environment and health monitoring and information systems are fundamental infrastructure for evidence provision for policy making. INPHET aims to address the vast inequalities across countries and communities in their ability to monitor, assess, inform and mitigate environmental and health issues. Its objectives and work support environmental epidemiology in its role as the pillar science that provides evidence for decision making and intervention aimed at reducing and preventing environmental related diseases, and contributes to an overall vision for public health.

Strengthening environmental health surveillance in low- and middle-income countries

We will describe work to develop and implement actionable frameworks for measuring progress of actions to promote children’s environmental health. Active health sector engagement to ensure the use of local data to inform policies and implementation will be described to underscore the value of ensuring sustained investments in surveillance, rather than one-off studies, to direct limited health resources. Applied examples will include 1) integrating and enhancing routinely collected data to quantify the impact of clean air policies in Indonesia and 2) targeting surveillance efforts to identify populations most at risk for increased blood levels in India and the Philippines.

DISTRIBUIÇÃO ESPACIAL DE FATORES DE RISCO E TEORES DE FLÚOR NA ÁGUA DE ABASTECIMENTO PÚBLICO EM ESCALA MUNICIPAL

Fluoridation of public water supplies is an important measure to prevent dental caries and is linked to Sustainable Development Objective 6. This study aimed to evaluate the fluoride content of Ceará's municipalities. The research used secondary data from SISAGUA (municipality; year, date, source and point of collection; form of supply; supply system; chlorine and fluoride concentrations) and the IBGE (HDI, population, FIRJAN Municipal Development Index, and estimated population) for spatial distribution and the analysis of fluoride risk factors. Of the 26,390 samples collected, only 17.8% had ideal fluoride content, with a higher prevalence in samples collected in 2016, in isolated urban areas, in water supply systems, and in chlorine levels above the ideal. Of the 182 municipalities evaluated, 16.7% had most of the samples with ideal fluoride content. In a multivariate analysis, municipalities with a population below 30 thousand inhabitants had a prevalence of inadequate fluoride content (below or above the ideal) 2.12 (95% CI = 1.92-4.88) times higher than municipalities with large populations. It is concluded that less than a fifth of Ceará's population is exposed to adequate public water fluoride levels, and cities with fewer than 30,000 inhabitants are the most affected. Keywords: Fluoride. Water Fluoridation. Environmental Health Surveillance. Health Geography.

One Health Paradigm to Confront Zoonotic Health Threats: A Pakistan Prospective.

The emergence and re-emergence of zoonotic diseases significantly impact human health, particularly those who live in impoverished areas and have close contact with domestic or wild animals. Nearly 75% of zoonotic diseases are transmitted directly from animals to humans or indirectly via vector/agent interactions between animals and humans. Growing populations, globalization, urbanization, and the interaction of the environment with humans and livestock all play roles in the emergence and spread of zoonotic diseases. “One Health” is a multidisciplinary concept aimed at improving human, animal, and environmental health, but this concept is not widely accepted in developing countries. In Pakistan, environmental, human, and animal health are severely affected due to a lack of sufficient resources. This review article provides an overview of the most common zoonotic diseases found in Pakistan and emphasizes the importance of the “One Health” concept in managing these diseases. Given the current situation, interdisciplinary research efforts are required to implement and sustain effective and long-term control measures in animal, human, and environmental health surveillance and accurate diagnostic methods.

The experience of the Professional Qualification Course in Environmental Health Surveillance: a polytechnical education proposal for SUS in Brazil

One of the main difficulties and challenges for the consolidation and operationalization of the environmental health policy in the Brazil’s Unified Public Health System (SUS) is the establishment of both processes and pedagogical strategies for training and professional education at high school and undergraduate levels that are capable to answer the demands and needs of this area. This study aimed to discuss the importance of the formative processes of the Professional Qualification Course in Environmental Health Surveillance and its relevance as a qualification strategy for the SUS. The methodology consisted in the qualitative analysis on the teaching-learning dimensions involved in the establishment of this formative strategy. The observed results indicate to the force of technical qualification in the development of skills and competencies with a purpose to criticality in working with the SUS. It was concluded that this course brought significant learning to the strategy of training workers attentive to the determinants and conditioning factors in health.

Natural radioactivity transfer factors from soil to plants in Wasit governorate marsh

Study on environmental radiation protection and determination of contamination of natural radionuclides such as 40K, 226Ra, and 228Ra/228Th in soil and plants is important for the protection of public health. The environmental health surveillance program to develop a subject of interest in environmental science is therefore necessary for the awareness and the benefit of mankind. This study is focused on the transfer factors (TFs) of isotopes from soil to plants. Transfer factor is a value used in evaluation studies on the impact of accidental release of radionuclide into the environment. 80 samples (40 reed plants and 40 soils) were collected from Dulmaj marsh. Dulmaj is in the southwest of Wasit and northeast of Diwaniyah. 40K, 226Ra, and 228Ra/228Th activities were measured by using NaI(Tl) 3"×3". 40K, 226Ra, and 228Ra/228Th activity concentrations ranged from 87 to 706, 1.2 to 35.7, and 2.6 to 17 Bq·kg-1, respectively in soil. 40K, 226Ra, and 228Ra/228Th activity concentrations ranged from 9.6 to 472, 0.26 to 30, and 0.09 to16.1 Bq·kg-1, dry mass respectively in the plants. The transition factors of 40K, 226Ra, and 228Ra/228Th ranged between 0.02 to 0.97, 0.07 to 0.99, 0.09 to 0.99, respectively. TFs had shown different values in all locations. However, all the rates of values of the TFs have been shown to be less than one.

Validation of a Cell-Based Assay for Detection of Active Shiga Toxins Produced by Escherichia coli in Water.

Shiga toxin-producing Escherichia coli (STEC) causes a wide spectrum of diseases, including hemorrhagic colitis and hemolytic uremic syndrome (HUS). Almost 5% of STEC infections result from waterborne exposures, yet there is no test listed in the EPA’s current Selected Analytical Methods for the detection of active Shiga toxins (Stxs) in water. In this study, a HeLa cell-based assay is validated for the detection of metabolically active Stxs produced by STEC in water, including tap, bottled, and pond water. Active Stxs are detected even when the number of Stx-producing bacteria is less than 0.4 CFU/mL and the assay performance is not affected by background flora or chlorine in the water. This assay is not only as simple and affordable as cell-free assays but also detects active holotoxins without the use of live animals. In addition, the assay is designed for use in multi-well formats, making it ideal for high-throughput screening of water samples and therefore useful for environmental public health surveillance programs to reduce human risk of infection with STEC.

Epidemiological research contributions to local policies of air quality management in the region of Aburra Valley in Colombia.

Area Metropolitana del Valle de Aburra- AMVA, environmental authority of ten municipalities in Colombia, has developed the Integrated Management Plan for Air Quality 2017-2030, whose thematic axis 1 proposes strategies such as the design and implementation of an Environmental Health Surveillance System, based on the strengthening of scientific bases and the development of a scientific research agenda. Since 2016, a collaborative process has been set up between AMVA and the public health academic sector in the región. In the first phase (2016-2017), a research of acute events associated to short-term exposure to air pollutants (daily increases of 10 µg/m3 of PM10, PM2.5 and O3) in vulnerable population (under 5 years of age and older adults 65 years old) for each municipality between 2008 and 2015 was developed. This research achieved important methodological developments, such as: 1) the processes of imputation of data of air pollutants not available and the assembly of unique series by municipality; 2) The identification of cases of sentinel events from health care records using data mining techniques and learn machine for traceability of records, 3) the construction of relational databases for big data analysis, 4 ) the automation of decision-making trees for the construction of explanatory GAM-type models, and 5) the analysis of critical contamination episodes. In its second phase (2017-2018) A prototype of a computational tool was designed in which methodological developments were integrated into data management and analysis. In the third phase (2018-2019), knowledge management processes were developed and epidemiological analyzes for Environmental Health Surveillance were perfected, as well as a web platform - SIVISA was created in order that community actors and decision makers can learn about the phenomenon, manage knowledge, design actions and follow local plans and policies.

Infectious diseases surveillance in the context of climate change: assessment of public health surveillance capacity in Nepal

The changing dynamics of infectious disease transmission under the influence of global environmental change, urbanization, population growth and increasing trends of travel and migration are challenging the conventional approach of disease surveillance, highlighting a need for inter-sectoral participation and interdisciplinary collaboration.A qualitative exploratory study design will be adopted to assess the capacity of the public health surveillance system in Nepal to examine impacts of climate change on infectious diseases transmission. A scoping review of related scientific journal articles and pertinent documents was carried out to identify major elements relevant to climate change and infectious disease surveillance. An evaluation framework was then designed, which will be utilized to analyse interview transcripts of epidemiologists, surveillance officers, infectious disease experts and policy makers from the Epidemiology and Disease Control Division, Nepal.We identified 10 major documents, including 6 peer reviewed articles, 2 surveillance guidelines (issued by the US Center for Disease Control and Prevention and the World Health Organisation) and 2 conference proceedings describing major themes and components relevant to public health surveillance (environmental health surveillance and disease surveillance). However, we did not identify any literature that provides a comprehensive framework for infectious disease surveillance in consideration with changing climate. Hence, we took pragmatic approach incorporating the concepts of environmental health surveillance and disease surveillance- in addition to policies relevant to climate change and human health- to propose a comprehensive framework of infectious disease surveillance in a changing climate. We are now using this framework to evaluate the capacity of infectious disease surveillance systems in Nepal in the context of climate change. Findings from our qualitative study will be presented.We propose a comprehensive framework for infectious disease surveillance in the context of climate change, which can be utilized for evaluation of infectious disease surveillance capacity in the context of changing climate.

Biomonitoring of metals in inhabitants of Northern Chile: implications of surveillance in areas with historical exposures

Background: The presence of toxic metals in human populations is strongly associated with chronic diseases and should be monitored especially in communities with a history of chronic exposures as occurs in northern Chile.Objective: to establish concentrations and prevalence of exposure to metals in residents of the city of Antofagasta, Chile, and its main risk factors.Methods: a cross-sectional study in Antofagasta was made. The sample (1203 adults) had populational representability at the city level. Sociodemographic information, health status, and sources of exposure to metals were collected in the participants. Urinary Inorganic Arsenic (InAs), Cadmium (Cd), Chromium (Cr) and Mercury (Hg) levels, and Lead (Pb) in blood were measured using NIOSH methodology by Inductively coupled plasma atomic emission spectroscopy (ICP-AES).Results:The sample had an average age of 42.7 years, with an average residence time in the city of 30 years, predominantly women (54.5%), high smoking (51.5%), high occupation rate in mining activities (22.6%).Using cutoff used by the health authorities (35µg /L for urinary InAs, the prevalence was 8% in adults and 12.3% in children. However, 75% of the population has levels below 21.9 µg / L. The main factors associated with high levels of urinary inorganic arsenic in adults were sex (β= 3.12, IC 95% 0.2-6.05 for males) and low schooling (β= 7.1, IC 95% 0.4-14.6 in people having less 8 y of education). People residing more than 500 meters from fixed sources had higher InAs levels. Other metals are below risk levels defined by health authorities.Conclusions It is urgent that in this city all the sources related to InAs must be verified and develop social interventions and environmental health surveillance in order to reduce involuntarily exposure to this metalloid.

Translation of Environmental Epidemiology into Public Health Action: An International Perspective titled The Perspective of the Pan American Health Organization for the Region of the Americas.

The Region of the Americas is diverse, complex, and unequal. About 13% of premature deaths in high-income countries and 19% in low- and middle-income countries are attributed to known avoidable environmental risks, amounting to about 1,016,000 deaths each year. The impact of these risks on premature mortality differs significantly among countries, ranging from 8% in Canada to 23% in Haiti. Important advances have been made to protect people’s health from environmental risks. Nonetheless, uneven development has left behind large populations across the Region. Environmental public health has suffered of an invisibility crisis in several countries. Roles and responsibilities of government agencies are unclear, surveillance systems are weak, the health sector has not assumed its environmental responsibilities, and cities and communities have only partially addressed the challenges of environmental determinants of health. Knowledge gaps, insufficient research to fill these gaps and limited research translation and communication continue to prevent efficient and effective implementation of public health actions. To address these challenges, the Pan American Health Organization has proposed an integrated and evidence-informed regional plan of action to systematize the response within the health sector and across sectors. The objective is to reduce the burden of disease and inequity in health attributable to environmental risks with emphasis on air pollution, chemical-related impacts, climate change-related impacts, and unsafe food, water, and sanitation. The implementation of the plan would follow four strategic lines of action: Improve the performance of environmental public health programs; strengthen environmental public health surveillance; foster an environmentally responsible and resilient health sector; and promote environmentally healthy and resilient communities. This is a call to action for intersectoral and multisectoral collaboration with a significant support from the academic community to close the existing knowledge gaps and help translate environmental epidemiology into public health action in the Americas.