NELSON DA CRUZ GOUVEIA

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Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 339 Citação(ões) na Scopus
    Maternal Exposure to Particulate Air Pollution and Term Birth Weight: A Multi-Country Evaluation of Effect and Heterogeneity
    (2013) DADVAND, Payam; PARKER, Jennifer; BELL, Michelle L.; BONZINI, Matteo; BRAUER, Michael; DARROW, Lyndsey A.; GEHRING, Ulrike; GLINIANAIA, Svetlana V.; GOUVEIA, Nelson; HA, Eun-hee; LEEM, Jong Han; HOOVEN, Edith H. van den; JALALUDIN, Bin; JESDALE, Bill M.; LEPEULE, Johanna; MORELLO-FROSCH, Rachel; MORGAN, Geoffrey G.; PESATORI, Angela Cecilia; PIERIK, Frank H.; PLESS-MULLOLI, Tanja; RICH, David Q.; SATHYANARAYANA, Sheela; SEO, Juhee; SLAMA, Remy; STRICKLAND, Matthew; TAMBURIC, Lillian; WARTENBERG, Daniel; NIEUWENHUIJSEN, Mark J.; WOODRUFF, Tracey J.
    BACKGROUND: A growing body of evidence has associated maternal exposure to air pollution with adverse effects on fetal growth; however, the existing literature is inconsistent. OBJECTIVES: We aimed to quantify the association between maternal exposure to particulate air pollution and term birth weight and low birth weight (LBW) across 14 centers from 9 countries, and to explore the influence of site characteristics and exposure assessment methods on between-center heterogeneity in this association. METHODS: Using a common analytical protocol, International Collaboration on Air Pollution and Pregnancy Outcomes (ICAPPO) centers generated effect estimates for term LBW and continuous birth weight associated with PM10 and PM2.5 (particulate matter <= 10 and 2.5 mu m). We used meta-analysis to combine the estimates of effect across centers (similar to 3 million births) and used meta-regression to evaluate the influence of center characteristics and exposure assessment methods on between-center heterogeneity in reported effect estimates. RESULTS: In random-effects meta-analyses, term LBW was positively associated with a 10-mu g/m(3) increase in PM10 [odds ratio (OR) = 1.03; 95% CI: 1.01, 1.05] and PM2.5 (OR = 1.10; 95% CI: 1.03, 1.18) exposure during the entire pregnancy, adjusted for maternal socioeconomic status. A 10-mu g/m(3) increase in PM10 exposure was also negatively associated with term birth weight as a continuous outcome in the fully adjusted random-effects meta-analyses (-8.9 g; 95% CI: -13.2, -4.6 g). Meta-regressions revealed that centers with higher median PM2.5 levels and PM2.5: PM10 ratios, and centers that used a temporal exposure assessment (compared with spatiotemporal), tended to report stronger associations. CONCLUSION: Maternal exposure to particulate pollution was associated with LBW at term across study populations. We detected three site characteristics and aspects of exposure assessment methodology that appeared to contribute to the variation in associations reported by centers.
  • article 44 Citação(ões) na Scopus
    The International Collaboration on Air Pollution and Pregnancy Outcomes: Initial Results
    (2011) PARKER, Jennifer D.; RICH, David Q.; GLINIANAIA, Svetlana V.; LEEM, Jong Han; WARTENBERG, Daniel; BELL, Michelle L.; BONZINI, Matteo; BRAUER, Michael; DARROW, Lyndsey; GEHRING, Ulrike; GOUVEIA, Nelson; GRILLO, Paolo; HA, Eunhee; HOOVEN, Edith H. van den; JALALUDIN, Bin; JESDALE, Bill M.; LEPEULE, Johanna; MORELLO-FROSCH, Rachel; MORGAN, Geoffrey G.; SLAMA, Remy; PIERIK, Frank H.; PESATORI, Angela Cecilia; SATHYANARAYANA, Sheela; SEO, Juhee; STRICKLAND, Matthew; TAMBURIC, Lillian; WOODRUFF, Tracey J.
    BACKGROUND: The findings of prior studies of air pollution effects on adverse birth outcomes are difficult to synthesize because of differences in study design. OBJECTIVES: The International Collaboration on Air Pollution and Pregnancy Outcomes was formed to understand how differences in research methods contribute to variations in findings. We initiated a feasibility study to a) assess the ability of geographically diverse research groups to analyze their data sets using a common protocol and b) perform location-specific analyses of air pollution effects on birth weight using a standardized statistical approach. METHODS: Fourteen research groups from nine countries participated. We developed a protocol to estimate odds ratios (ORs) for the association between particulate matter <= 10 mu m in aerodynamic diameter (PM(10)) and low birth weight (LBW) among term births, adjusted first for socioeconomic status (SES) and second for additional location-specific variables. RESULTS: Among locations with data for the PM(10) analysis, ORs estimating the relative risk of term LBW associated with a 10-mu g/m(3) increase in average PM(10) concentration during pregnancy, adjusted for SES, ranged from 0.63 [95% confidence interval (CI), 0.30-1.35] for the Netherlands to 1.15 (95% CI, 0.61-2.18) for Vancouver, with six research groups reporting statistically significant adverse associations. We found evidence of statistically significant heterogeneity in estimated effects among locations. CONCLUSIONS: Variability in PM(10)-LBW relationships among study locations remained despite use of a common statistical approach. A more detailed meta-analysis and use of more complex protocols for future analysis may uncover reasons for heterogeneity across locations. However, our findings confirm the potential for a diverse group of researchers to analyze their data in a standardized way to improve understanding of air pollution effects on birth outcomes.
  • article 35 Citação(ões) na Scopus
    Ambient fine particulate matter in Latin American cities: Levels, population exposure, and associated urban factors
    (2021) GOUVEIA, Nelson; KEPHART, Josiah L.; DRONOVA, Iryna; MCCLURE, Leslie; GRANADOS, Jose Tapia; BETANCOURT, Ricardo Morales; O'RYAN, Andrea Cortinez; TEXCALAC-SANGRADOR, Jose Luis; MARTINEZ-FOLGAR, Kevin; RODRIGUEZ, Daniel; V, Ana Diez-Roux
    Background: Exposure to particulate matter (PM2.5) is a major risk factor for morbidity and mortality. Yet few studies have examined patterns of population exposure and investigated the predictors of PM2.5 across the rap-idly growing cities in lower- and middle-income countries. Objectives: Characterize PM2.5 levels, describe patterns of population exposure, and investigate urban factors as predictors of PM2.5 levels. Methods: We used data from the Salud Urbana en America Latina/Urban Health in Latin America (SALURBAL) study, a multi-country assessment of the determinants of urban health in Latin America, to characterize PM2.5 levels in 366 cities comprising over 100,000 residents using satellite-derived estimates. Factors related to urban form and transportation were explored. Results: We found that about 172 million or 58% of the population studied lived in areas with air pollution levels above the defined WHO-AQG of 10 mu g/m(3) annual average. We also found that larger cities, cities with higher GDP, higher motorization rate and higher congestion tended to have higher PM2.5. In contrast cities with higher population density had lower levels of PM2.5. In addition, at the sub-city level, higher intersection density was associated with higher PM2.5 and more green space was associated with lower PM2.5. When all exposures were examined adjusted for each other, higher city per capita GDP and higher sub-city intersection density remained associated with higher PM2.5 levels, while higher city population density remained associated with lower levels. The presence of mass transit was also associated with lower PM2.5 after adjustment. The motorization rate also remained associated with PM2.5 and its inclusion attenuated the effect of population density. Discussion: These results show that PM2.5 exposures remain a major health risk in Latin American cities and suggest that urban planning and transportation policies could have a major impact on ambient levels. (C) 2021 The Author(s).
  • article 82 Citação(ões) na Scopus
    Building a Data Platform for Cross-Country Urban Health Studies: the SALURBAL Study
    (2019) QUISTBERG, D. Alex; ROUX, Ana V. Diez; BILAL, Usama; MOORE, Kari; ORTIGOZA, Ana; RODRIGUEZ, Daniel A.; SARMIENTO, Olga L.; FRENZ, Patricia; FRICHE, Amelia Augusta; CAIAFFA, Waleska Teixeira; VIVES, Alejandra; MIRANDA, J. Jaime; ALAZRAQUI, Marcio; SPINELLI, Hugo; GUEVEL, Carlos; CECCO, Vanessa Di; TISNES, Adela; LEVEAU, Carlos; SANTORO, Adrian; HERKOVITS, Damian; GOUVEIA, Nelson; BARRETO, Mauricio; SANTOS, Gervasio; CARDOSO, Leticia; MENEZES, Mariana Carvalho de; PINA, Maria de Fatima de; CAIAFFA, Waleska Teixeira; FRICHE, Amelia Augusta de Lima; ANDRADE, Amanda Cristina de Souza; FRENZ, Patricia; ALFARO, Tania; CORDOVA, Cynthia; RUIZ, Pablo; FUENTES, Mauricio; VERGARA, Alejandra Vives; SALAZAR, Alejandro; CORTINEZ-O'RYAN, Andrea; SCHMITT, Cristian; GONZALEZ, Francisca; BAEZA, Fernando; ANGELINI, Flavia; DUENAS, Olga Lucia Sarmiento; HIGUERA, Diana; GONZALEZ, Catalina; MONTES, Felipe; USECHE, Andres F.; GUAJE, Oscar; JARAMILLO, Ana Maria; GUZMAN, Luis Angel; HESSEL, Philipp; LUCUMI, Diego; MEISEL, Jose David; MARTINEZ, Eliana; KROKER-LOBOS, Maria F.; RAMIREZ-ZEA, Manuel; FOLGER, Kevin Martinez; BARRIENTOS-GUTIERREZ, Tonatiuh; PEREZ-FERRER, Carolina; PRADO-GALBARRO, Javier; CASTRO, Filipa de; ROJAS-MARTINEZ, Rosalba; MIRANDA, J. Jaime; VASQUEZ, Akram Hernandez; DIEZ-CANSECO, Francisco; HAMMOND, Ross; RODRIGUEZ, Daniel; DRONOVA, Iryna; SANCHEZ, Brisa N.; HOVMAND, Peter; FUCHS, Ricardo Jordan; BRASLOW, Juliet; SIRI, Jose; ROUX, Ana Diez; AUCHINCLOSS, Amy; LANGELLIER, Brent; LOVASI, Gina; MCCLURE, Leslie; MICHAEL, Yvonne; QUICK, Harrison; QUISTBERG, D. Alex; GRANADOS, Jose Tapia; MOORE, Kari; GARCIA-ESPANA, Felipe; BILAL, Usama; STANKOV, Ivana
    Studies examining urban health and the environment must ensure comparability of measures across cities and countries. We describe a data platform and process that integrates health outcomes together with physical and social environment data to examine multilevel aspects of health across cities in 11 Latin American countries. We used two complementary sources to identify cities with 100,000 inhabitants as of 2010 in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, and Peru. We defined cities in three ways: administratively, quantitatively from satellite imagery, and based on country-defined metropolitan areas. In addition to cities, we identified sub-city units and smaller neighborhoods within them using census hierarchies. Selected physical environment (e.g., urban form, air pollution and transport) and social environment (e.g., income, education, safety) data were compiled for cities, sub-city units, and neighborhoods whenever possible using a range of sources. Harmonized mortality and health survey data were linked to city and sub-city units. Finer georeferencing is underway. We identified 371 cities and 1436 sub-city units in the 11 countries. The median city population was 234,553 inhabitants (IQR 141,942; 500,398). The systematic organization of cities, the initial task of this platform, was accomplished and further ongoing developments include the harmonization of mortality and survey measures using available sources for between country comparisons. A range of physical and social environment indicators can be created using available data. The flexible multilevel data structure accommodates heterogeneity in the data available and allows for varied multilevel research questions related to the associations of physical and social environment variables with variability in health outcomes within and across cities. The creation of such data platforms holds great promise to support researching with greater granularity the field of urban health in Latin America as well as serving as a resource for the evaluation of policies oriented to improve the health and environmental sustainability of cities.
  • article 15 Citação(ões) na Scopus
    The 2022 South America report of The Lancet Countdown on health and climate change: trust the science. Now that we know, we must act
    (2023) HARTINGER, Stella M.; YGLESIAS-GONZALEZ, Marisol; BLANCO-VILLAFUERTE, Luciana; PALMEIRO-SILVA, Yasna K.; LESCANO, Andres G.; STEWART-IBARRA, Anna; ROJAS-RUEDA, David; MELO, Oscar; TAKAHASHI, Bruno; BUSS, Daniel; CALLAGHAN, Max; CHESINI, Francisco; FLORES, Elaine C.; POSSE, Carolina Gil; GOUVEIA, Nelson; JANKIN, Slava; MIRANDA-CHACON, Zaray; MOHAJERI, Nahid; HELO, Juliana; ORTIZ, Laura; PANTOJA, Chrissie; SALAS, Maria Fernanda; SANTIAGO, Raquel; SERGEEVA, Milena; CAMARGO, Tatiana Souza de; VALDES-VELASQUEZ, Armando; WALAWENDER, Maria; ROMANELLO, Marina
  • article 3 Citação(ões) na Scopus
    Greenness and excess deaths from heat in 323 Latin American cities: Do associations vary according to climate zone or green space configuration?
    (2023) SCHINASI, Leah H.; BAKHTSIYARAVA, Maryia; SANCHEZ, Brisa N.; KEPHART, Josiah L.; JU, Yang; ARUNACHALAM, Sarav; GOUVEIA, Nelson; CAIAFFA, Waleska Teixeira; O'NEILL, Marie S.; DRONOVA, Iryna; ROUX, Ana V. Diez; RODRIGUEZ, Daniel A.
    Green vegetation may protect against heat-related death by improving thermal comfort. Few studies have investigated associations of green vegetation with heat-related mortality in Latin America or whether associations are modified by the spatial configuration of green vegetation. We used data from 323 Latin American cities and meta-regression models to estimate associations between city-level greenness, quantified using populationweighted normalized difference vegetation index values and modeled as three-level categorical terms, and excess deaths from heat (heat excess death fractions [heat EDFs]). Models were adjusted for city-level fine particulate matter concentration (PM2.5), social environment, and country group. In addition to estimating overall associations, we derived estimates of association stratified by green space clustering by including an interaction term between a green space clustering measure (dichotomized at the median of the distribution) and the three-level greenness variable. We stratified analyses by climate zone (arid vs. temperate and tropical combined). Among the 79 arid climate zone cities, those with moderate and high greenness levels had modestly lower heat EDFs compared to cities with the lowest greenness, although protective associations were more substantial in cities with moderate versus high greenness levels and confidence intervals (CI) crossed the null (Beta: -0.41, 95% CI: -1.06, 0.25; Beta -0.23, 95% CI: -0.95, 0.49, respectively). In 244 non-arid climate zone cities, associations were approximately null. We did not observe evidence of effect modification by green space clustering. Our results suggest that greenness may offer modest protection against heat-related mortality in arid climate zone Latin American cities.
  • article 9 Citação(ões) na Scopus
    Associations of Urban Environment Features with Hypertension and Blood Pressure across 230 Latin American Cities
    (2022) AVILA-PALENCIA, Ione; RODRIGUEZ, Daniel A.; MIRANDA, J. Jaime; MOORE, Kari; GOUVEIA, Nelson; MORAN, Mika R.; CAIAFFA, Waleska T.; ROUX, Ana V. Diez
    BACKGROUND: Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. OBJECTIVES: We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. METHODS: In this cross-sectional study we used health, social, and built environment data from the SALud URBana en America Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS: A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase =1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR = 1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase = 0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase = 1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. DISCUSSION: Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning.
  • article 5 Citação(ões) na Scopus
    Corresponding author at: .
    (2023) DELCLOS-ALIO, Xavier; KANAI, Claudio; SORIANO, Lucas; QUISTBERG, D. Alex; JU, Yang; DRONOVA, Iryna; GOUVEIA, Nelson; RODRIGUEZ, Daniel A.
    Car use creates significant externalities for urban residents worldwide. City characteristics such as the configuration of the urban landscape and street network likely influence the use and attractiveness of automobiles, especially in rapidly urbanizing areas such as Latin America. The understanding of factors associated with motorization can inform planning measures to reduce car usage, and to promote healthier, safer, and more sustainable urban lifestyles. We harmonized official passenger vehicle data from 300 cities with >100,000 inhabitants in Brazil, Chile, Colombia, and Mexico, and we calculated urban landscape metrics from satellite imagery and street network metrics from OpenStreetMaps. Analyzed cities had an average of 273.3 cars per 1,000 residents in 2015 and showed an average car rate increase of 30 % between 2010 and 2015. We used negative binomial regression to examine the association between car rates and urban landscape and street network characteristics, and linear regression to examine the association between the same characteristics and car rate increases. Car rates in the 300 cities analyzed showed a partial positive association with development fragmentation, and a consistent positive association with urban form complexity and circuity of the street network. In addition, the increase in car rates between 2010 and 2015 showed a negative association with population density. Implementing regional policies to reduce development fragmentation, to promote compact urban forms and less circuitous street networks may help reducing motorization in Latin American cities. Special attention needs to be paid to low density areas, where the increase in vehicle rates has been more pronounced.
  • article 60 Citação(ões) na Scopus
    City-level impact of extreme temperatures and mortality in Latin America
    (2022) KEPHART, Josiah L.; SANCHEZ, Brisa N.; MOORE, Jeffrey; SCHINASI, Leah H.; BAKHTSIYARAVA, Maryia; JU, Yang; GOUVEIA, Nelson; CAIAFFA, Waleska T.; DRONOVA, Iryna; ARUNACHALAM, Saravanan; ROUX, Ana V. Diez; RODRIGUEZ, Daniel A.
    Climate change and urbanization are rapidly increasing human exposure to extreme ambient temperatures, yet few studies have examined temperature and mortality in Latin America. We conducted a nonlinear, distributed-lag, longitudinal analysis of daily ambient temperatures and mortality among 326 Latin American cities between 2002 and 2015. We observed 15,431,532 deaths among approximate to 2.9 billion person-years of risk. The excess death fraction of total deaths was 0.67% (95% confidence interval (CI) 0.58-0.74%) for heat-related deaths and 5.09% (95% CI 4.64-5.47%) for cold-related deaths. The relative risk of death was 1.057 (95% CI 1.046-1.067%) per 1 degrees C higher temperature during extreme heat and 1.034 (95% CI 1.028-1.040%) per 1 degrees C lower temperature during extreme cold. In Latin American cities, a substantial proportion of deaths is attributable to nonoptimal ambient temperatures. Marginal increases in observed hot temperatures are associated with steep increases in mortality risk. These risks were strongest among older adults and for cardiovascular and respiratory deaths. An ecological analysis of 326 cities in 9 countries across Latin America found that changes in ambient temperature have a substantial contribution to all-cause mortality, with small increases in extreme heat associated with steep increases in mortality risk.
  • article 31 Citação(ões) na Scopus
    Health Effects of Pesticide Exposure in Latin American and the Caribbean Populations: A Scoping Review
    (2022) ZúñIGA-VENEGAS, L. A.; HYLAND, C.; MUñOZ-QUEZADA, M. T.; Quirós-Alcalá L.; BUTINOF, M.; BURALLI, R.; CARDENAS, A.; FERNANDEZ, R. A.; FOERSTER, C.; GOUVEIA, N.; JARA, J. P. G.; LUCERO, B. A.; MUñOZ, M. P.; RAMíREZ-SANTANA, M.; SMITH, A. R.; TIRADO, N.; JOODE, B. W. de; CALAF, G. M.; HANDAL, A. J.; SILVA, A. S. da; CORTéS, S.; MORA, A. M.
    BACKGROUND: Multiple epidemiological studies have shown that exposure to pesticides is associated with adverse health outcomes. However, the literature on pesticide-related health effects in the Latin American and the Caribbean (LAC) region, an area of intensive agricultural and residential pesticide use, is sparse. We conducted a scoping review to describe the current state of research on the health effects of pesticide exposure in LAC populations with the goal of identifying knowledge gaps and research capacity building needs. METHODS: We searched PubMed and SciELO for epidemiological studies on pesticide exposure and human health in LAC populations published between January 2007 and December 2021. We identified 233 publications from 16 countries that met our inclusion criteria and grouped them by health outcome (genotoxicity, neurobehavioral outcomes, placental outcomes and teratogenicity, cancer, thyroid function, reproductive outcomes, birth outcomes and child growth, and others). RESULTS: Most published studies were conducted in Brazil (37%, n = 88) and Mexico (20%, n = 46), were cross-sectional in design (72%, n = 167), and focused on farmworkers (45%, n = 105) or children (21%, n = 48). The most frequently studied health effects included genotoxicity (24%, n = 62) and neurobehavioral outcomes (21%, n = 54), and organophosphate (OP) pesticides were the most frequently examined (26%, n = 81). Forty-seven percent (n = 112) of the studies relied only on indirect pesticide exposure assessment methods. Exposure to OP pesticides, carbamates, or to multiple pesticide classes was consistently associated with markers of genotoxicity and adverse neurobehavioral outcomes, particularly among children and farmworkers. DISCUSSION: Our scoping review provides some evidence that exposure to pesticides may adversely impact the health of LAC populations, but methodological limitations and inconsistencies undermine the strength of the conclusions. It is critical to increase capacity building, integrate research initiatives, and conduct more rigorous epidemiological studies in the region to address these limitations, better inform public health surveillance systems, and maximize the impact of research on public policies. © 2022, Public Health Services, US Dept of Health and Human Services. All rights reserved.