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Fish constitutes the main protein source for the Amazonian population. However, the impact of different anthropogenic activities on trace element and metal accumulation in fish and their risks for human health at a regional scale remain largely unexplored. Here we assessed exposure levels of 10 trace elements and metals (Cr, Mn, Fe, Ni, Cu, Zn, As, Cd, Pb, and Hg) in 56 samples belonging to 11 different species of fish from the Brazilian Amazon. We studied the relationship between exposure levels, fish origin, and fish feeding habits, and assessed toxicological and carcinogenic risks for the Amazonian population. No significant correlation was found between sampling site and exposure levels to the studied elements, but a significant difference was found between the accumulation of some metals and the position of the fish species in the food chain. The concentrations of Cr and Hg in fish flesh were found to exceed the Brazilian limits for human consumption. This study shows that current fish consumption patterns can lead to estimated daily intakes of Hg, As and Cr that exceed the oral reference dose, thus posing a toxicological concern. Furthermore, carcinogenic risks may be expected due to the continued exposure to Cr and As. The results of this study show that the consumption of wild caught fish in the Amazon region should be controlled. Moreover, continued monitoring of trace element and metal contamination in fish and on the health of the Amazonian population is recommended, particularly for riverine and indigenous communities.

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Abstract In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD's etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety.

Resumo Nas últimas décadas, uma epidemia de doença renal crônica (DRC) tem sido associada a fatores ambientais e ocupacionais (estresse térmico decorrente de cargas de trabalho elevadas em altas temperaturas e exposição a produtos químicos, como agrotóxicos e metais), denominada DRC de origem não tradicional (DRCnt). Esta revisão descritiva tem como objetivo apresentar evidências recentes sobre estresse térmico, agrotóxicos e metais como possíveis causas de DRCnt e fornecer uma visão geral das estratégias brasileiras de regulamentação, fiscalização e vigilância sanitária relacionadas. Os trabalhadores brasileiros são comumente expostos a condições extremas de calor e outros fatores de risco de DRCnt, incluindo o aumento da exposição a agrotóxicos e metais. Além disso, há uma falta de regulamentação e fiscalização, políticas públicas e estratégias adequadas para proteger a saúde renal dos trabalhadores em relação aos principais fatores de risco. É provável que a DRCnt seja uma causa significativa de DRC no Brasil, uma vez que a etiologia da doença é desconhecida em muitos pacientes e diversas condições para seu desenvolvimento estão presentes no país. Estudos epidemiológicos devem ser realizados para explorar associações causais e estimar o impacto do calor, dos agrotóxicos e dos metais na DRCnt no Brasil. Além disso, as políticas públicas devem priorizar a redução da exposição dos trabalhadores e a promoção de sua saúde e segurança.

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INTRODUCTION: Veterinary oncology is constituted mainly by human-use drugs with hazardous agents. Occupational risks are present in all stages of handling. Many studies highlighted that veterinarians and pharmacists staff present a lack of knowledge and insufficient structure for promoting safety practices. This study investigated the professional profile and structure of veterinary antineoplastic chemotherapy in Brazilian services. METHODS: A nationwide survey was carried out through digital platforms by a self-applicable from 2020 to 2021. The characteristics of the structure, facilities, professional profiles, practices related to antineoplastic chemotherapy services, and inspections provided by regulatory companies were investigated. Frequency and ranges were used to examine and describe data. RESULTS: This study analyzed 108 respondents from all Brazilian regions where 36 participants worked in veterinary oncology. Dogs and cats comprised more than 90% of animals assisted. Vincristine, doxorubicin, carboplatin, vinblastine, and cyclophosphamide were the most commonly used drugs. Considering pharmacists-led (n = 4) vs veterinarians-led (n = 18) services, structure with safety for handling hazardous drugs (4 vs 9), correct PPE usage (3 vs 0), and occurrence of occupational accident (0 vs 5) were registered. Almost 60% were dissatisfied with the structure and the managerial unwillingness to promote facility improvements. The majority of participants reported an absence of service inspection. CONCLUSION: The results demonstrated worrying concerning the inadequacy of the physical structure of the facilities, human resources, and handling hazardous drugs increased occupational health risk. The lack of competent authority standards and supervision corroborates practices that expose professionals, the population, and the environment to hazardous agents.

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This work assessed the psychosocial risks of 124 workers from the plywood industry in Ecuador's Amazon region. Two psychosocial risk assessment (PRA) methods were selected due to their widespread use in Ecuadorian organisations: FPSICO from the Spanish National Institute for Occupational Safety and Health and the "Psychosocial Risk Assessment Questionnaire" (PRAQ) from the Ecuadorian Labour Ministry. Therefore, two surveys of 89 and 58 items were applied to evaluate nine scales and eight risk dimensions for FPSICO and PRAQ, respectively. Results show that according to FPSICO, the main psychosocial risks were detected in the scales of working time (WT), variety and content (VC), and workload (WL), with a prevalence of 34.8 % and 41.7 %. For PRAQ, the margin of action and control (D4), load and work rate (D1), and leadership (D3) were the most affected dimensions, with a risk prevalence between 29.1 % and 43.6 %. Although there is a lower risk prevalence in the rest of the scales and dimensions assessed, improvement actions are needed in the short term. Furthermore, the findings suggest an association between gender and risk prevalence, especially in the dimensions of Leadership (D3), Skills development (D2), and Self-perceived health (D8.8), where being a woman increases the likelihood of suffering from these conditions by up to three times. In addition, a brief comparative analysis was conducted, looking for coincidences in the scales that each PRA instrument assesses and the prevalence of the psychosocial risks detected.

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Composite end points are common primary outcomes in clinical trials. Their main benefit of utilizing a composite outcome is increasing the number of primary outcome events, meaning fewer participants are required to deliver an adequately powered trial. By combining multiple important end points in the primary outcome rather than having to select only 1, composite end points potentially make clinically meaningful benefits easier to detect and avoid ranking outcomes hierarchically. However, there are a number of important considerations when designing and interpreting clinical trials that utilize composite end points. In this Statistical Primer, issues with composite end points such as competing events, halo effect, risk of bias, time-to-event limitations and the win ratio are discussed in the context of real world clinical trials.

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BACKGROUND: Risk factors that can result in serious injuries or deaths are frequently not understood or prevented because of the traditional way in which organizations approach safety. This is especially true for falls from heights in the construction sector, which remain a leading safety hazard in construction globally. METHODS: A theoretical framework derived from a thorough review of international evidence provided the foundation for the conduct of 50 structured focus groups with a total of 209 participants representing construction workers and supervisors in two main Chilean construction contractor companies and their subcontractors. RESULTS: A total of 627 precursors (risk factors), 56 taxonomies (work tasks/activities), and 622 defenses (prevention actions) were identified. These were classified in three macro dimensions and 13 subdimensions in total, providing a comprehensive framework for the origin, manifestation, and neutralization of such precursors. DISCUSSION: The findings provide a useful framework for understanding of the most critical risks to which workers are exposed and actions to prevent them. This framework should form the basis for the development of practical safety programs and tools such as management and training checklists, and data analysis for early warning signs.

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OBJECTIVE: The aim of this study was to analyse the attributable risk of mortality and DALYs (Disability Adjusted Life Years) due to occupational carcinogens for lung cancer between 1990 and 2019 in Brazil and federation units, as well as its relationship with the Socio-demographic Index (SDI). STUDY DESIGN: Epidemiological study. METHODS: This is an epidemiological study that used GBD 2019 (Global Burden of Disease Study) estimates of lung cancer mortality rates and DALYs attributable to occupational carcinogens. The relationship between these rates and SDI was assessed using panel data analysis. RESULTS: In Brazil, occupational exposure to asbestos, silica and diesel vapours accounted for more than 85.00% of lung cancer deaths and DALYs attributable to occupational carcinogens in both sexes between 1990 and 2019. An increase in both rates was observed in women for almost all the occupational carcinogens assessed, especially in the North and Northeast regions of the country, with diesel vapours standing out the most. CONCLUSIONS: The present study highlighted the urge to characterise exposure to occupational risks for lung cancer, especially for the female population in the North and Northeast regions of Brazil.

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INTRODUCTION: In some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the Peritoneal Equilibrium Test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007-2017 using a competing risk model. MATERIALS AND METHODS: A retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a Peritoneal Equilibration Test (PET) between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). RESULTS: Patients were classified into four categories based on the PET result: Slow/Low transfer (16.0%), low average (35.4%), high average (32.9%), and High/Fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98-1.30) p = 0.078, high average 1.08 (95% CI 0.96-1.22) p = 0.195, low average 1.09 (95% CI 0.96-1.22) p = 0.156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98-1.52) p = 0.66, high average HR was 1.10 (95% CI 0.91-1.33) p = 0.296, low average HR of 1.03 (95% CI 0.85-1.24) p = 0.733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. CONCLUSIONS: When evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

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The aim of this study is to analyze the spatiotemporal risk of congenital syphilis (CS) in high-prevalence areas in the city of São Paulo, SP, Brazil, and to evaluate its relationship with socioeconomic, demographic, and environmental variables. An ecological study was conducted based on secondary CS data with spatiotemporal components collected from 310 areas between 2010 and 2016. The data were modeled in a Bayesian context using the integrated nested Laplace approximation (INLA) method. Risk maps showed an increasing CS trend over time and highlighted the areas that presented the highest and lowest risk in each year. The model showed that the factors positively associated with a higher risk of CS were the Gini index and the proportion of women aged 18-24 years without education or with incomplete primary education, while the factors negatively associated were the proportion of women of childbearing age and the mean per capita income.

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Road deposited sediments (RDS) are important sinks of potentially toxic elements (PTEs), which may have a significant impact on human health. A systematic review of published papers on the PTEs occurrence in RDS was carried out. The main goal was to assess the global RDS contamination by PTEs and human health risks linked with anthropogenic activities. A systematic search was made to collect information about the most cited PTEs in the published literature and perform a statistical analysis. Subsequently, health risks were assessed for 35 different areas worldwide. PTE concentrations showed high variability, and means were multiple times higher than the corresponding consensus-based threshold effect concentrations (5.2-, 10.3-, 5.3-, 3-, 7.3-, and 3.6-fold higher for Zn, Pb, Ni, Cr, Cu, and Cd, respectively). PTEs concentrations were ranked as Zn > Pb > Cu > Mn > Cr > Ni > Cd. Non carcinogenic risks followed the trend Pb > Cu > Zn > Cd. Lead is responsible for the highest significant non carcinogenic risk to human health. Unacceptable exposition to carcinogenic risks is present in most areas. The top carcinogenic risk areas were Singapore > Beijing > Yixing > Shanghai > Zhuzhou for adult male, Dresden > Singapore > Ulsan > Huludao for adult females, and Dresden > Singapore > Ulsan > Huludao for children. Highest chromium and nickel carcinogenic risks occurred in Singapore, Cd in Dresden, and Cu in Huludao. Highest RDS contamination was seen in industrial areas due to pollutants deposition. Highest Zn, Cu, Cd, and Pb concentrations occur in densely urbanized areas due to heavy-duty vehicular exhausts.

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In 2023, a series of climatological and political events unfolded, partly driving forward the global climate and health agenda while simultaneously exposing important disparities and vulnerabilities to climate-related events. On the policy front, a significant step forward was marked by the inaugural Health Day at COP28, acknowledging the profound impacts of climate change on health. However, the first-ever Global Stocktake showed an important gap between the current progress and the targets outlined in the Paris Agreement, underscoring the urgent need for further and decisive action. From a Latin American perspective, some questions arise: How do we achieve the change that is needed? How to address the vulnerabilities to climate change in a region with long-standing social inequities? How do we promote intersectoral collaboration to face a complex problem such as climate change? The debate is still ongoing, and in many instances, it is just starting. The renamed regional centre Lancet Countdown Latin America (previously named Lancet Countdown South America) expanded its geographical scope adding Mexico and five Central American countries: Costa Rica, El Salvador, Guatemala, Honduras, and Panama, as a response to the need for stronger collaboration in a region with significant social disparities, including research capacities and funding. The centre is an independent and multidisciplinary collaboration that tracks the links between health and climate change in Latin America, following the global Lancet Countdown's methodologies and five domains. The Lancet Countdown Latin America work hinges on the commitment of 23 regional academic institutions, United Nations agencies, and 34 researchers who generously contribute their time and expertise. Building from the first report, the 2023 report of the Lancet Countdown Latin America, presents 34 indicators that track the relationship between health and climate change up to 2022, aiming at providing evidence to public decision-making with the purpose of improving the health and wellbeing of Latin American populations and reducing social inequities through climate actions focusing on health. This report shows that Latin American populations continue to observe a growing exposure to changing climatic conditions. A warming trend has been observed across all countries in Latin America, with severe direct impacts. In 2022, people were exposed to ambient temperatures, on average, 0.38 °C higher than in 1986-2005, with Paraguay experiencing the highest anomaly (+1.9 °C), followed by Argentina (+1.2 °C) and Uruguay (+0.9 °C) (indicator 1.1.1). In 2013-2022, infants were exposed to 248% more heatwave days and people over 65 years old were exposed to 271% more heatwave days than in 1986-2005 (indicator 1.1.2). Also, compared to 1991-2000, in 2013-2022, there were 256 and 189 additional annual hours per person, during which ambient heat posed at least moderate and high risk of heat stress during light outdoor physical activity in Latin America, respectively (indicator 1.1.3). Finally, the region had a 140% increase in heat-related mortality from 2000-2009 to 2013-2022 (indicator 1.1.4). Changes in ecosystems have led to an increased risk of wildfires, exposing individuals to very or extremely high fire danger for more extended periods (indicator 1.2.1). Additionally, the transmission potential for dengue by Aedes aegypti mosquitoes has risen by 54% from 1951-1960 to 2013-2022 (indicator 1.3), which aligns with the recent outbreaks and increasing dengue cases observed across Latin America in recent months. Based on the 2023 report of the Lancet Countdown Latin America, there are three key messages that Latin America needs to further explore and advance for a health-centred climate-resilient development. Latin American countries require intersectoral public policies that simultaneously increase climate resilience, reduce social inequities, improve population health, and reduce greenhouse gas (GHG) emissions. The findings show that adaptation policies in Latin America remain weak, with a pressing need for robust vulnerability and adaptation (V&A) assessments to address climate risks effectively. Unfortunately, such assessments are scarce. Up to 2021, Brazil is the only country that has completed and officially reported a V&A to the 2021 Global Survey conducted by the World Health Organization (WHO). Argentina, Guatemala, and Panama have also conducted them, but they have not been reported (indicator 2.1.1). Similarly, efforts in developing and implementing Health National Adaptation Plans (HNAPs) are varied and limited in scope. Brazil, Chile, and Uruguay are the only countries that have an HNAP (indicator 2.1.2). Moreover, self-reported city-level climate change risk assessments are very limited in the region (indicator 2.1.3). The collaboration between meteorological and health sectors remains insufficient, with only Argentina, Brazil, Colombia, and Guatemala self-reporting some level of integration (indicator 2.2.1), hindering comprehensive responses to climate-related health risks in the region. Additionally, despite the urgent need for action, there has been minimal progress in increasing urban greenspaces across the region since 2015, with only Colombia, Nicaragua, and Venezuela showing slight improvements (indicator 2.2.2). Compounding these challenges is the decrease in funding for climate change adaptation projects in Latin America, as evidenced by the 16% drop in funds allocated by the Green Climate Fund (GCF) in 2022 compared to 2021. Alarmingly, none of the funds approved in 2022 were directed toward climate change and health projects, highlighting a critical gap in addressing health-related climate risks (indicator 2.2.3). From a vulnerability perspective, the Mosquito Risk Index (MoRI) indicates an overall decrease in severe mosquito-borne disease risk in the region due to improvements in water, sanitation, and hygiene (WASH) (indicator 2.3.1). Brazil and Paraguay were the only countries that showed an increase in this indicator. It is worth noting that significant temporal variation within and between countries still persists, suggesting inadequate preparedness for climate-related changes. Overall, population health is not solely determined by the health sector, nor are climate policies a sole responsibility of the environmental sector. More and stronger intersectoral collaboration is needed to pave development pathways that consider solid adaptation to climate change, greater reductions of GHG emissions, and that increase social equity and population health. These policies involve sectors such as finance, transport, energy, housing, health, and agriculture, requiring institutional structures and policy instruments that allow long-term intersectoral collaboration. Latin American countries need to accelerate an energy transition that prioritises people's health and wellbeing, reduces energy poverty and air pollution, and maximises health and economic gains. In Latin America, there is a notable disparity in energy transition, with electricity generation from coal increasing by an average of 2.6% from 1991-2000 to 2011-2020, posing a challenge to efforts aimed at phasing out coal (indicator 3.1.1). However, this percentage increase is conservative as it may not include all the fossil fuels for thermoelectric electricity generation, especially during climate-related events and when hydropower is affected (Panel 4). Yet, renewable energy sources have been growing, increasing by an average of 5.7% during the same period. Access to clean fuels for cooking remains a concern, with 46.3% of the rural population in Central America and 23.3% in South America lacking access to clean fuels in 2022 (indicator 3.1.2). It is crucial to highlight the concerning overreliance on fossil fuels, particularly liquefied petroleum gas (LPG), as a primary cooking fuel. A significant majority of Latin American populations, approximately 74.6%, rely on LPG for cooking. Transitioning to cleaner heating and cooking alternatives could also have a health benefit by reducing household air pollution-related mortality. Fossil fuels continue to dominate road transport energy in Latin America, accounting for 96%, although some South American countries are increasing the use of biofuels (indicator 3.1.3). Premature mortality attributable to fossil-fuel-derived PM2.5 has shown varied trends across countries, increasing by 3.9% from 2005 to 2020 across Latin America, which corresponds to 123.5 premature deaths per million people (indicator 3.2.1). The Latin American countries with the highest premature mortality rate attributable to PM2.5 in 2020 were Chile, Peru, Brazil, Colombia, Mexico, and Paraguay. Of the total premature deaths attributable to PM2.5 in 2020, 19.1% was from transport, 12.3% from households, 11.6% from industry, and 11% from agriculture. From emission and capture of GHG perspective, commodity-driven deforestation and expansion of agricultural land remain major contributors to tree cover loss in the region, accounting for around 80% of the total loss (indicator 3.3). Additionally, animal-based food production in Latin America contributes 85% to agricultural CO2 equivalent emissions, with Argentina, Brazil, Panama, Paraguay, and Uruguay ranking highest in per capita emissions (indicator 3.4.1). From a health perspective, in 2020, approximately 870,000 deaths were associated with imbalanced diets, of which 155,000 (18%) were linked to high intake of red and processed meat and dairy products (indicator 3.4.2). Energy transition in Latin America is still in its infancy, and as a result, millions of people are currently exposed to dangerous levels of air pollution and energy poverty (i.e., lack of access to essential energy sources or services). As shown in this report, the levels of air pollution, outdoors and indoors, are a significant problem in the wholeregion, with marked disparities between urban and rural areas. In 2022, Peru, Chile, Mexico, Guatemala, Colombia, El Salvador, Brazil, Uruguay, Honduras, Panama, and Nicaragua were in the top 100 most polluted countries globally. Transitioning to cleaner sources of energy, phasing out fossil fuels, and promoting better energy efficiency in the industrial and housing sectors are not only climate mitigation measures but also huge health and economic opportunities for more prosperous and healthy societies. Latin American countries need to increase climate finance through permanent fiscal commitments and multilateral development banks to pave climate-resilient development pathways. Climate change poses significant economic costs, with investments in mitigation and adaptation measures progressing slowly. In 2022, economic losses due to weather-related extreme events in Latin America were US$15.6 billion -an amount mainly driven by floods and landslides in Brazil-representing 0.28% of Latin America's Gross Domestic Product (GDP) (indicator 4.1.1). In contrast to high-income countries, most of these losses lack insurance coverage, imposing a substantial financial strain on affected families and governments. Heat-related mortality among individuals aged 65 and older in Latin America reached alarming levels, with losses exceeding the equivalent of the average income of 451,000 people annually (indicator 4.1.2). Moreover, the total potential income loss due to heat-related labour capacity reduction amounted to 1.34% of regional GDP, disproportionately affecting the agriculture and construction sectors (indicator 4.1.3). Additionally, the economic toll of premature mortality from air pollution was substantial, equivalent to a significant portion of regional GDP (0.61%) (indicator 4.1.4). On a positive note, clean energy investments in the region increased in 2022, surpassing fossil fuel investments. However, in 2020, all countries reviewed continued to offer net-negative carbon prices, revealing fossil fuel subsidies totalling US$23 billion. Venezuela had the highest net subsidies relative to current health expenditure (123%), followed by Argentina (10.5%), Bolivia (10.3%), Ecuador (8.3%), and Chile (5.6%) (indicator 4.2.1). Fossil fuel-based energy is today more expensive than renewable energy. Fossil fuel burning drives climate change and damages the environment on which people depend, and air pollution derived from the burning of fossil fuels causes seven million premature deaths each year worldwide, along with a substantial burden of disease. Transitioning to sustainable, zero-emission energy sources, fostering healthier food systems, and expediting adaptation efforts promise not only environmental benefits but also significant economic gains. However, to implement mitigation and adaptation policies that also improve social wellbeing and prosperity, stronger and solid financial systems are needed. Climate finance in Latin American countries is scarce and strongly depends on political cycles, which threatens adequate responses to the current and future challenges. Progress on the climate agenda is lagging behind the urgent pace required. While engagement with the intersection of health and climate change is increasing, government involvement remains inadequate. Newspaper coverage of health and climate change has been on the rise, peaking in 2022, yet the proportion of climate change articles discussing health has declined over time (indicator 5.1). Although there has been significant growth in the number of scientific papers focusing on Latin America, it still represents less than 4% of global publications on the subject (indicator 5.3). And, while health was mentioned by most Latin American countries at the UN General Debate in 2022, only a few addressed the intersection of health and climate change, indicating a lack of awareness at the governmental level (indicator 5.4). The 2023 Lancet Countdown Latin America report underscores the cascading and compounding health impacts of anthropogenic climate change, marked by increased exposure to heatwaves, wildfires, and vector-borne diseases. Specifically, for Latin America, the report emphasises three critical messages: the urgent action to implement intersectoral public policies that enhance climate resilience across the region; the pressing need to prioritise an energy transition that focuses on health co-benefits and wellbeing, and lastly, that need for increasing climate finance by committing to sustained fiscal efforts and engaging with multilateral development banks. By understanding the problems, addressing the gaps, and taking decisive action, Latin America can navigate the challenges of climate change, fostering a more sustainable and resilient future for its population. Spanish and Portuguese translated versions of this Summary can be found in Appendix B and C, respectively. The full translated report in Spanish is available in Appendix D.

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Objetivo: Desenvolver intervenção educativa sobre gerenciamento dos resíduos de serviços de saúde e uso de equipamentos de proteção individual com profissionais de enfermagem. Métodos: Pesquisa-ação, realizada com profissionais de enfermagem de um hospital da rede pública no nordeste brasileiro, entre janeiro a julho de 2018. Os dados foram organizados com apoio do software webQDA© e análise de conteúdo de Bardin. Resultados: Emergiram duas categorias: Gerenciamento dos Resíduos de Serviços de Saúde e Utilização de Equipamentos de Proteção Individuais. Parte dos profissionais possuíam conhecimento adequado sobre o gerenciamento dos resíduos de serviços de saúde. Os resultados apontam que parcela dos participantes reconhecem a periculosidade que os grupos de resíduos de serviços de saúde possuem, adotando cuidados, porém, reconhecem a ocorrência de condutas não seguras, como uso incorreto de equipamentos de proteção individual. Além disso, os técnicos de enfermagem demostraram conhecimento incipiente sobre os resíduos de serviços de saúde e expressaram mais exposição a riscos ocupacionais. Conclusão: A intervenção educativa realizada evidenciou a necessidade de efetivar a construção de conhecimentos coletivos no âmbito da educação permanente relacionado aos resíduos e riscos ocupacionais entre profissionais de enfermagem. Recomendam-se outros estudos para avaliar a efetividade e impacto da intervenção educativa no ambiente hospitalar. (AU)

Objective: Develop educational intervention on health care waste management and the use of personal protective equipment with nursing professionals. Methods: Action research, carried out with nursing professionals from a public hospital in northeastern Brazil, between January and July 2017. The data were organized with the support of webQDA © software and content analysis by Bardin. Results: Two categories emerged: Waste Management from Health Services and Use of Personal Protective Equipment. Part of the professionals had adequate knowledge about the management of waste from health services. The results show that a portion of the participants recognize the dangerousness that the health service waste groups have, adopting care in relation to these, however, they recognize the occurrence of unsafe conduct, such as incorrect use of personal protective equipment. In addition, nursing technicians demonstrated incipient knowledge about health service waste and expressed more exposure to occupational risks. Conclusion: The educational intervention carried out showed the need to carry out the construction of collective knowledge within the scope of permanent education related to GRSS and occupational risks among nursing professionals. Further studies are recommended to assess the effectiveness and impact of educational intervention in the hospital environment. (AU)

Objetivo: Desarrollar una intervención educativa sobre la gestión de residuos sanitarios y el uso de equipos de protección personal con profesionales de enfermería. Métodos: Investigación acción, realizada con la profesión de un hospital público en el noreste de Brasil, entre enero y julio de 2017. Los datos se organizan con el apoyo del software webQDA © y el análisis de contenido Bardin. Resultados: Surgieron dos categorías: Gestión de dos Residuos de Servicios de Salud y Uso de Equipos de Protección Personal. Los profesionales de la segunda parte tienen el conocimiento o manejo adecuado de dos residuos de los servicios de salud. Los resultados indican que dos participantes reconsideran la peligrosidad que representaban los grupos de residuos del servicio de salud, adhiriéndose cuidados, por lo que reconsideran la ocurrencia de conductas inseguras, como el uso incorrecto de equipos de protección personal. Además, los técnicos de enfermería demostrarán un conocimiento incipiente sobre el desperdicio de servicios de salud y expresarán una mayor exposición a los riesgos laborales. Conclusión: La intervención educativa realizada mostró la necesidad de realizar la construcción de conocimientos colectivos fuera del ámbito de la educación permanente relacionada con los GRSS y los riesgos laborales entre los profesionales de la enfermedad. Recomendamos otros estudios para evaluar la efectividad y el impacto de la intervención educativa en el ámbito hospitalario. (AU)

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Objetivo: Verificar associação entre a percepção de risco para infecções sexualmente transmissíveis e variáveis sociocomportamentais de universitários. Métodos: Estudo transversal, realizado com 655 estudantes de ensino superior. A amostragem foi probabilística por conglomerados. Utilizou-se um questionário estruturado para coleta de dados. A análise estatística foi realizada no Statistical Package for Social Sciences. Resultados: Maioria do sexo feminino, com média de 23 anos de idade, cor não branca, solteira/separada e de religião católica. Houve associação significativa entre percepção de risco e a idade, religião, orientação sexual, idade da sexarca, realização do teste do Vírus da Imunodeficiência Humana, número de parcerias e uso de preservativo com parceiro fixo. Conclusão: Foi possível confirmar que a percepção de risco é realmente uma variável importante, e que, a sua ausência pode ser um fator determinante para adoção de comportamentos considerados arriscados para aquisição de infecções sexualmente transmissíveis, como maior número de parcerias sexuais e baixa adesão ao preservativo. (AU)

Objective: to verify the existence of an association between the perception of risk and socio-behavioral variables of university students. Methods: Cross-sectional study with 655 students of higher education. Sampling was probabilistic by clusters; A structured questionnaire was used for data collection. Statistical analysis was performed in the Statistical Package for Social Sciences. Results: The majority were female, with a mean age of 23 years, non-white, single / separated / widowed and Catholic. There was a significant association between risk perception and gender, age, religion, sexual orientation, sexarche age, Human Immunodeficiency Virus testing, number of sexual partnerships and condom use with a fixed partner. Conclusion: It was possible to confirm that risk perception is a really important variable and the lack of it can be a determining factor for the adoption of risky behaviors associated with the acquisition of sexually transmitted infections, like greater number of sexual partnerships and low adherence to condoms. (AU)

Objetivo: Verificar la existencia de asociación entre la percepción del riesgo y variables de comportamiento de la universidad colaboradora. Métodos: Estudio cuantitativo, analítico realizado con 655 estudiantes universitarios. La muestra fue probabilística por conglomerados; Se utilizó un cuestionario con 60 preguntas objetivas. Los datos fueron analizados mediante el paquete estadístico para las Ciencias Sociales. Este trabajo sigue los lineamientos de la Resolución 466/2012 del SNC. Resultados: La mayoría eran mujeres con una media de 23 años, no blanco, Individual / Separado / viuda, y católica. Se observó una asociación significativa entre la percepción del riesgo y el género, la edad, la religión, la orientación sexual, la edad sexarche, la realización de la prueba del Vírus de Inmunodeficiencia Humana, número de parejas sexuales y el uso del condón con parejas habituales. Conclusión: Se pudo constatar que la percepción de riesgo es realmente una variable importante, y que su ausencia puede ser un factor determinante para la adopción de conductas consideradas de riesgo para la adquisición de infecciones de transmisión sexual, como mayor número de parejas sexuales y baja adherencia al condón. (AU)

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The threat landscape of biological hazards with the evolution of AI presents challenges. While AI promises innovative solutions, concerns arise about its misuse in the creation of biological weapons. The convergence of AI and genetic editing raises questions about biosecurity, potentially accelerating the development of dangerous pathogens. The mapping conducted highlights the critical intersection between AI and biological threats, underscoring emerging risks in the criminal manipulation of pathogens. Technological advancement in biology requires preventative and regulatory measures. Expert recommendations emphasize the need for solid regulations and responsibility of creators, demanding a proactive, ethical approach and governance to ensure global safety.

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BACKGROUND: Health professionals in Colombian and many parts of the world, in some cases, work in precarious conditions and intend to migrate to other countries in search of better living conditions for themselves and their families, which results in inadequate distribution worldwide and in the quality of care throughout the health system, which can ultimately influence the quality of life of patients in their health-disease processes. PURPOSE: Describe in depth what quality of life at work is like for the health workforce in adult critical care (ACC). METHODS: This is an investigation of convergent parallel mixed methods approach that are integrated by means of a matrix in terms of convergence, divergence, and complementarity. Two methods are used: a transversal analytical method in which three instruments were applied to 209 participants to study the relationship between Quality of Life at Work, exposure to psychosocial risks, compassion fatigue and the intention to rotate; other than from the experiences narrated by 10 Human Talent in Health explore organizational practices in critical care. RESULTS: The dimension of quality of work life with the greatest dissatisfied was the management of free time (77%), the most compromised psychosocial risk was the pace of work (84%). They have high compassion satisfaction (67%) and there is an intention to migrate to another country (66%). The narrative results in discrimination/harassment as normalized practices and faceless spirituality. The integration of mixed methods shows convergence between the use of the instrument that measures quality of life at work and the narratives of the participants, complementarity with the other instruments, and divergence regarding the intention to rotate to another health institution. CONCLUSION: The positive trend that converges with the two approaches is that of safety at work and well-being achieved through work, embodied in the constant updating of technology and care protocols, experience time, balance between salary and work effort, staffing and supplies, and disconnection with work.

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The steel industry is a significant worldwide source of atmospheric particulate matter (PM). Part of PM may settle (SePM) and deposit metal/metalloid and metallic nanoparticles in aquatic ecosystems. However, such an air-to-water cross-contamination is not observed by most monitoring agencies. The region of Vitoria City is the main location of iron processing for exports in Brazil, and it has rivers, estuaries, and coastal areas affected by SePM. We have evaluated the effects of SePM on a local representative fish species, the fat snook, Centropomus parallelus. After acclimation, 48 fishes (61.67 ± 27.83 g) were individually exposed for 96 h to diverse levels of SePM (0.0, 0.01, 0.1 and 1 g/L-1). The presence of metals in the blood and several blood biomarkers were analyzed to evaluate the impact of SePM on stress signaling, blood oxygen transport capacity, and innate immune activity. Metal bioaccumulation was measured from blood in two separately analyzed compartments: intracellular (erythrocytes plus white blood cells) and extracellular (plasma). The major metals present at all contamination levels in both compartments were Fe and Zn, followed by Al and Cu, plus traces of 'Emerging metals': Ba, Ce, La, Rb, Se, Sr, and Ti. Emerging metals refer to those that have recently been identified in water as contaminants, encompassing rare earth elements and critical technology elements, as documented in previous studies (See REEs and TCEs in Cobelo-García et al., 2015; Batley et al., 2022). Multivariate analysis revealed that SePM had strong, dose-dependent correlations with all biomarker groups and indicated that blood oxygen-carrying capacity had the highest contamination responsiveness. Metal contamination also increased cortisol and blood glucose levels, attesting to increased stress signaling, and had a negative effect on innate immune activity. Knowledge of the risks related to SePM contamination remains rudimentary. However, the fact that there was metal bioaccumulation, causing impairment of fundamental physiological and cellular processes in this ecologically relevant fish species, consumed by the local human population, highlights the pressing need for further monitoring and eventual control of SePM contamination.

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In Brazil, the favorable weather conditions and abundant land contribute to the thriving agricultural production. Brazilian crops extensively employ pesticides due to their high efficacy, cost-effectiveness, and permissive regulatory framework. However, pesticide use also endangers water resources, animal organisms, and human health. Due to the lack of data on pesticide use in the Amazonas forest-based Brazil, the present study aimed to assess the levels of twenty-one current-use pesticides (CUPs) from five different classes in river waters collected from urban and riverside areas in this region. Moreover, the non-carcinogenic risks associated with water consumption were also characterized. Thirteen CUPs were detected in concentrations above the limit of detection (LOD) in at least one of the water samples, and most pesticides were detected in riverside areas. In contrast, only 18% of the analyzed samples were considered "clean," with only one compound detected. Fenitrothion showed the highest concentration, with a mean value of 4.86 ng/mL (0.30-14.3 ng/mL). Up to 33% of the samples showed levels of fipronil above the LOD, an issue of environmental and human health concern, mainly because of the adverse effects observed in honeybees. Despite this, the human health risk assessment showed a target hazard quotient below one (HQ < 1) in adults for all substances, suggesting that pesticide exposure through water consumption should not mean risk for the riverside populations. Taking into account the large extension of Brazil, as well as its different agricultural practices throughout the country, it would be of great importance to conduct extensive research in other areas. It would help to gain knowledge in this field and to promote eco-friendly alternatives to mitigate pesticide use and, consequently, to reduce their potential adverse effects on human health and the ecosystems.

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Artisanal mining is intensely carried out in developing countries, including Brazil and especially in the Amazon. This method of mineral exploration generally does not employ mitigation techniques for potential damages and can lead to various environmental problems and risks to human health. The objectives of this study were to quantify the concentrations of rare earth elements (REEs) and estimate the environmental and human health risks in cassiterite and monazite artisanal mining areas in the southeastern Amazon, as well as to understand the dynamics of this risk over time after exploitation. A total of 35 samples of wastes classified as overburden and tailings in active areas, as well as in areas deactivated for one and ten years were collected. Samples were also collected in a forest area considered as a reference site. The concentrations of REEs were quantified using alkaline fusion and ICP-MS. The results were used to calculate pollution indices and environmental and human health risks. REEs showed higher concentrations in anthropized areas. Pollution and environmental risk levels were higher in areas deactivated for one year, with considerable contamination factors for Gd and Sm and significant to extreme enrichment factors for Sc. Human health risks were low (< 1) in all studied areas. The results indicate that artisanal mining of cassiterite and monazite has the potential to promote contamination and enrichment by REEs.

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Work through mobile applications emerged as an alternative for many Brazilian men during the economic crisis and rising unemployment. However, these workers operate informally, without a formal employment relationship, leading to labor precariousness and a lack of workers' rights. Using a theoretical-reflexive, this study analyzes the intersection between occupational health, the platformization of work, and the specific challenges faced by male delivery app workers, especially during the COVID-19 pandemic. Reflective categories are divided into two thematic sections: "Labor insertion through mobile applications in Brazil and the algorithmic work model" and "men, health, and motorcycles: occupational health and male behavior in app-based delivery work." The study examines the expansion of this type of work in the Brazilian socio-economic context, the lack of security and labor protection for these workers, as well as the risks faced, particularly during the pandemic, within a male-centric culture.

El trabajo a través de aplicaciones móviles surgió como una alternativa para muchos hombres brasileños durante la crisis económica y el aumento del desempleo. Sin embargo, estos trabajadores operan de manera informal, sin relación laboral, lo que genera precariedad laboral y falta de derechos laborales. Desde un abordaje teórico-reflexivo, este artículo analiza la intersección entre la salud ocupacional, la plataformización del trabajo y los desafíos específicos que enfrentan los hombres repartidores de aplicaciones, especialmente durante la pandemia de covid-19. Las categorías reflexivas se dividieron en dos secciones temáticas: "La inserción laboral a través de aplicaciones móviles en Brasil y el modelo de trabajo mediante algoritmos" y "hombres, salud y motocicletas: la salud ocupacional y el comportamiento masculino en el trabajo a través de aplicaciones de entrega". Se examina la expansión de este tipo de trabajo en el contexto socioeconómico brasileño, la falta de seguridad y protección laboral para estos trabajadores, así como los riesgos enfrentados, especialmente durante la pandemia, en el marco de una cultura masculina.

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Mercury contamination in the Amazon arising from both natural sources and intensive mining activities in the region is a significant public health concern. This metal is used to separate Au from sediments. Accordingly, this study aimed to assess the impact of mining on mercury contamination in the animal and human populations of the Amazon. This overall objective was pursued through a systematic review of the existing literature to assess the impact of Hg and identify gaps in geographic coverage arising from this assessment. Herein, we employed PECO and PRISMA-ScR protocols to select articles published between 2017 and 2023 based on projected points on a map within the biogeographic boundaries of the Amazon. We found that mercury concentrations increase with trophic levels, reaching high values of 3.7 µg/g in the muscles of predatory fish and 34.9 µg/g in human hair. The mean level of mercury in human hair in the whole (Amazon) region exceeds 6 µg/g, surpassing tolerance levels. Although mining regions show high concentrations of Hg, the highest incidence was observed among populations with fish-based diets. It was concluded that continuous research and monitoring of fish in the region are required in order to accurately assess the risk associated with Hg contamination, especially since fish are the main source of protein in this region.