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As temperatures defy heat records, it is difficult to ignore the implications of climate change for public health, including impacts on population health more specifically. In short, climate change is happening now and presents an immediate hazard to human health on a global scale. Age-related health effects are an inalienable truth; physiology is relatively universal, and so are the ways in which our bodies respond to different types and levels of exposures to environmental stressors at different lifestages. Children are uniquely vulnerable to climate change stressors not only due to their physical and developmental immaturity, but also because they generally rely on adult caretakers for the fundamentals of survival. This article is the summary piece accompanying a special issue of Environmental Research: Health. It compiles new studies on children’s vulnerability to climate change as well as studies exploring climate adaptation strategies to promote and protect child health. In this special issue, we see how these concepts are reflected repeatedly in empirical data domestically and internationally. For example, the special issue includes articles investigating linkages between climate change and health hazards such as asthma, injuries, and malnutrition. While local context is extremely important, many of the health effects may be extrapolated to other communities around the world.

Objectives: Night-shift work has been associated with several negative effects on worker’s health, possibly due to circadian desynchronization, sleep deprivation and suppression of nocturnal melatonin secretion including exposure to light during the work shift. The objective of this study was to evaluate the impact of fixed night-shift work versus day-shift work on the sleep-wake cycle and on the night and day levels of cortisol and melatonin. Material and Methods: Saliva samples were obtained from 36 individuals, 19 day workers (12 women and 7 men) and 17 night workers (12 women and 5 men) from a university hospital in southern Brazil, with no history of chronic diseases. Demographic and personal information were obtained through a self-administered questionnaire and sleep information by the Munich chronotype questionnaire. Results: Salivary cortisol showed normal circadian rhythm in day- and night-shift workers, but was attenuated in night-shift workers during their working hours and on leave days. Night workers sleep fewer hours at night and have higher negative social jet lag than day workers. Conclusion: Intervals between night shifts can be beneficial for the recovery of the hypothalamic-pituitary-adrenal axis, minimizing the negative effects on workers’ health, in addition to a preventive approach to aspects related to sleep hygiene and healthy life habits.

INTRODUCTION: Human cytomegalovirus (HCMV) is often reactive in latently infected immunosuppressed patients. Accordingly, HCMV remains one of the most common infections following solid organ and hemopoietic stem cell transplantations, resulting in significant morbidity, graft loss and occasional mortality. The early diagnosis of HCMV disease is important in immunosuppressed patients, since in these individuals, preemptive treatment is useful. The objective of this study was to compare the performance of the in-house qualitative polymerase chain reaction (PCR) and pp65 antigenemia to HCMV infection in immunosuppressed patients in the Hospital de Clínicas of Porto Alegre (HCPA). METHODS: A total of 216 blood samples collected between August 2006 and January 2007 were investigated. RESULTS: Among the samples analyzed, 81 (37.5%) were HCMV-positive by PCR, while 48 (22.2%) were positive for antigenemia. Considering antigenemia as the gold standard, sensitivity, specificity, positive predictive values and negative predictive values for PCR were 87.5%, 76.8%, 51.8% and 95.5% respectively. CONCLUSIONS: These results demonstrated that qualitative PCR has high sensitivity and negative predictive value (NPV). Consequently PCR is especially indicated for the initial diagnosis of HCMV infection. In the case of preemptive treatment strategy, identification of patients at high-risk for HCMV disease is fundamental and PCR can be useful tool.

Introdução: A infecção por citomegalovírus (CMV) é freqüente e acomete com significativa morbimortalidade indivíduos i-munossuprimidos, especialmente transplantados e pacientes HIV positivos com doença avançada. Objetivo: Este estudo visou a comparar o desempenho dos métodos reação em cadeia da polimerase qualitativo (PCR) e antigenemia pp65 para o diagnóstico de infecção por CMV em pacientes imunossuprimidos. Métodos: O estudo foi realizado em 216 amostras de sangue total coletadas de 85 pacientes, entre agosto de 2006 e janeiro de 2007, provenientes da internação ou ambulatório do Hospital de Clínicas de Porto Alegre (HCPA). Resultados: Entre as 216 amostras analisadas, 35 amostras apresentaram resultados positivos e 181 amostras apresentaram resultados negativos em uma e/ou outra técnica. Destas 35 amostras positivas, 16 foram positivas em ambas as técnicas; 12 apresentaram-se positivas pela PCR e negativas pela antigenemia; e sete amostras apresentaram-se positivas pela antigenemia e negativas pela PCR. Considerando a antigenemia como padrão-ouro, a técnica de PCR mostrou sensibilidade de 69,6%, especificidade de 93,8%, valor preditivo positivo de 57,1% e valor preditivo negativo de 96,3%. O coeficiente de correlação kappa foi de 0,578. Discussão: Este resultado demonstra que a PCR qualitativa apresenta moderada sensibilidade e alta especifi-cidade para o diagnóstico de infecção para CMV. Apesar de suas limitações, pode ser utilizada para exclusão do diagnóstico em pacientes com suspeita de infecção por CMV, por ser um método mais simples, de baixo custo e de fácil execução.