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Os efluentes líquidos gerados nas atividades hospitalares podem causar impactos ambientais negativos se mal gerenciados. O funcionamento de forma contínua e o atendimento a um público grande e heterogêneo muitas vezes contribuem para um consumo significativo de recursos hídricos e, consequente geração de efluentes líquidos. Nesta pesquisa, foi realizada a caracterização dos efluentes líquidos gerados e diagnóstico dos possíveis motivos de ocorrência dos parâmetros não conformes. O estudo foi realizado de julho a outubro de 2019, em um hospital público de Minas Gerais. A coleta de dados se deu a partir do registro institucional consolidado das análises do efluente no período de 2016 a 2019. Os resultados apontam que os principais parâmetros que destoam do estabelecido pela Norma Técnica 187/5 é a Demanda Química de Oxigênio (DQO). Entre os 22 parâmetros analisados, as medianas do ponto AM01 foram maiores para 16 parâmetros. No ponto AM02 somente os parâmetros boro total, fenóis totais, fluoretos totais, sólidos em suspensão totais, surfactantes e sulfatos apresentaram medianas superiores ao ponto AM01. Também pode-se observar uma correlação positiva e alta entre os parâmetros DBO e DQO para ambos os pontos. Foi constatada a variação das características de toxicidade dos efluentes do hospital estudado, especialmente devido aos parâmetros monitorados que estão associados aos materiais descartados.

A legislação brasileira define que o manejo dos resíduos de serviço de saúde (RSS) deve ocorrer com base em um plano de gerenciamento de resíduos e este deve ser monitorado a fim de verificar a efetividade das ações propostas. As auditorias são ferramentas amplamente adotadas no ambiente empresarial, que permitem a verificação do status dos processos. A auditoria relacionada ao gerenciamento de resíduos pode apontar ineficiências, estimar os custos reais do manejo e indicar o nível de conformidade do auditado com regulamentos e legislações. O objetivo deste estudo foi avaliar os benefícios da auditoria ambiental como ferramenta de monitoramento da implantação do plano de gerenciamento dos RSS (PGRSS) de uma instituição, bem como a análise das não-conformidades identificadas no período estudado. Foi realizada uma auditoria por ano durante o período de 2016 a 2018, sendo auditadas 33 laboratórios em 2016, 41 em 2017 e 47 em 2018. As maiores não conformidades identificadas no período entre 2016 e 2018 estavam relacionadas a ausência de registros/procedimentos sobre limpeza de lixeiras (29 não conformidades) e falta de identificação das lixeiras (13 não conformidades). Para os itens relacionados a descarte incorreto de EPI’s, presença de kits para recicláveis em laboratório, reposição inadequada de sacos para resíduos e locais de armazenamento sem identificação não foram encontradas não conformidades. Verifica-se um aumento do número de não conformidades em 2017 em relação a 2016. Tal fato pode estar relacionado ao aumento do número de laboratórios auditados em 2017. Em 2018 foram auditados 6 laboratórios a mais em relação a 2017 e o número de não conformidades registradas foi menor, podendo indicar uma melhoria nos processos de gerenciamento de resíduos. A ferramenta de auditoria adotada neste estudo de caso permitiu dar ênfase nos problemas mais recorrentes, indicando ao gestor potenciais focos a serem priorizados para a tomada de decisões visando a melhoria contínua do processo.

Este estudo objetivou analisar o quantitativo e tipos de Resíduos de Serviços de Saúde (RSS) gerados em uma instituição hospitalar à época do início da implantação do Plano de Gerenciamento de Resíduos de Serviços de Saúde (PGRSS) (2013), comparando com os dados de geração dos dias atuais (2020). Visando assim, discutir potencialidades e desafios inerentes à sua estruturação nos serviços, identificar alterações sazonais ou mesmo correlacionadas à pandemia da Covid-19. Trata-se de um estudo descritivo e exploratório, de natureza quantitativa. Os dados foram obtidos em planilhas do PGRSS da instituição, contendo registros diários da pesagem dos RSS. Os dados sugerem uma influência positiva da implantação do PGRSS na redução de resíduos vez que, embora tenha se observado o aumento do quantitativo de resíduos infectantes e químicos, identificou-se a redução dos resíduos comuns, sugerindo melhorias na segregação dos resíduos potencialmente contaminados e que remetem ao maior risco para a saúde coletiva e o meio ambiente.

Healthcare waste (HCW) management is a challenge for establishments that generate this type of waste, especially hospitals, as they are one of the largest generators. A determining factor in waste management is the amount of waste generation, which must be used for management planning. This study aims to compile and evaluate information on the management of HCW generated in Belo Horizonte's (located in Brazil) hospitals declared in their respective Healthcare Waste Management Plans (HCWMP) sent for approval by the municipality's Superintendency of Urban Cleaning. Therefore, a comparative analysis of the hospitals' generations in relation to their characteristics (nature, specialty, and size) was carried out, using the Kruskal-Wallis statistical test with post hoc in Nemenyi. For the study hospitals, a generation rate of 7.18 (6.17-8.23) kg·bed

There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals' healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal-Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world.

Over time, a growing increase in human pollutants in the aquatic environment has been observed. The global presence of residues in water bodies reinforces the need to develop improved methods to detect them and evaluate their ecotoxicological effects in the aquatic environment. Thus, this study aimed to present the main assays using B. glabrata as a biological model for ecotoxicological studies. We performed a systematic literature review with data published up to June 2022 in the Science Direct, PubMed, and SciELO databases. Twenty-six studies were selected for this review after screening. B. glabrata has been studied as an ecotoxicological model for different substances through toxicity, embryotoxicity, cytotoxicity, genotoxicity and bioaccumulation assays. Studies evaluating the impact of Biomphalaria glabrata exposure to several substances have reported toxic effects, behavioral and reproductive effects, and effects on their offspring. This review presents various assays using Biomphalaria glabrata as a biological model for ecotoxicological studies. The increasing number of studies conducted with the snail provides a preview of the snail’s potential as a biological model for ecotoxicological studies.

Diante da intensa degradação ambiental dos corpos d’água com poluentes emergentes, esse trabalho aborda a questão controversa sobre hormônios nas águas naturais e os malefícios dos mesmos. Objetivando o desenvolvimento de competências dos alunos do ensino técnico de uma instituição privada, as seguintes estratégias didáticas foram utilizadas: visitas técnicas, entrevistas e júri simulado. Os resultados foram apresentados conforme teoria ator-rede (ANT), em uma matriz polêmica na qual algumas realidades colaterais foram representadas, partindo de diferentes pontos de vista e demonstrando o benefício de tais vivências no processo de ensino da educação ambiental.

Concern over the management of chemical wastes from laboratories has been gaining importance since the 1990s. For a good management of chemical wastes generated from laboratories, it is recommended that managers encourage an environment of cooperation and exchange, thus reusing chemical reagents. The institution under study implemented the Chemical Waste Exchange, whose objective is to capture reagents past their expiry dates that would be discarded and make them available internally to other areas or even to other institutions. A total of 1075 reagents were reused internally and 4382 items were donated for external institutions. As for financial data, between 2011 and 2018, the internal economy was US$16,700.70 and for external institutions it was US$62,633.11. When comparing the waste reuse according to the destination, an internal address showed a significant difference when compared with the external use. Some categories of reagents have greater added value and provide even greater benefits when reused. The strategy of capturing and making available expired reagents through the Chemical Waste Exchange is positive; it helps the management of the waste generated; the economic benefit will depend on the market value of the material; the adopted strategy avoids the need to remove raw material from nature for the production of new reagents and reduces the costs related to treatment and environmentally appropriate final destination.

Background Waste pickers are considered a vulnerable population at risk for potential health damage. Taking into account the risk of hepatitis B or C infection in this population, the aim of this study was to show the prevalence of these diseases in waste pickers from South America, through a systematic review. Methods The search covered publications until February 2020, accessed through Google Scholar database. Epidemiological studies on hepatitis B or C focused on waste pickers in South America were included. All selected papers were evaluated for quality. Results Six studies composed this systematic review, all conducted in Brazil and using cross-sectional study. The prevalence of all makers (HBsAg or anti-HBc) for hepatitis B varied from 4.3 to 33.4% while for hepatitis C varied from 1.6 to 12.4%. Conclusion The lack of results showed the requirement for more research about hepatitis including this informal workers group. High prevalences of hepatitis B and C in waste pickers highlighted the need of increase preventive health protection as vaccination against hepatitis B; training on working conditions; and the use of individual protection.

Background: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines. Methods: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management. Results: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment. Conclusions: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.

Goal: To assess body mass index (BMI) changes in people living with HIV (PLHIV) and using antiretroviral therapy (ART) with dolutegravir (DTG) and its associated factors. Methods: Retrospective and prospective cohorts of PLHIV who started ART with DTG or used DTG after changing the therapeutic regimen, from Belo Horizonte, between February/2017 and March/2020. Data were gathered from clinical records of the Drug Logistics and Laboratory Test Control Systems. BMI changes were analyzed in the following week intervals 1-24(t24), 25-48(t48), 49-72(t73), and 73-96(t96) using the Wilcoxon test and generalized estimation equation (GEE) model, at 5% significance level. Results: A total of 614 individuals were included and average was 38.4 years old. Most were men (85.5%) and 52.3% had started ART with DTG. These individuals, and the immunosuppressed ones, showed significant increases in BMI when compared to those who used DTG after switching therapeutics or the non-immunosuppressed ones (p-value

Coronavirus-19 disease (COVID-19) acquired pandemic status in March 2020. The new virus has caused serious implications in the healthcare services management, including several sectors, among them the generation of waste. Healthcare wastes (HCW) generation increased along pandemic representing a health problem due to potentially infected ones. From this perspective, the study sought to analyse the challenges and changes imposed by COVID-19 in the HCW management in a large public hospital from Brazil. For this purpose, data about the Contingency Plan prepared by the hospital and HCW generation from 2017 to 2020 were used, analysed by statistical methods. When dealing with the Contingency Plan, the Brazilian hospital adopted measures similar to other hospitals around the world as described by the literature, such as: adoption of new protocols, specific team assigned to manage actions and training of professionals and suspension of elective surgeries. Regarding the generation of HCW, there was a significant increase in the mass of biological waste with a high risk of infection. The waste of this group increased from March 2020, coinciding with the start of care for the patients infected by COVID-19. The contribution of this type of waste to total generation jumped from approximately 0.2% in previous years to almost 5% in 2020. In addition, a reduction in the average of total waste generated in kilogrammes per bed per day from 2017 to 2019 was indicated compared to the 2020. COVID-19 pandemic led to major challenges for hospitals that had to care for patients infected with the SARS-CoV-2 virus, including new protocols, changing the work shifts and training the teams in the new procedures. The biological waste with a high risk of infectiousness also increased 30 times.

Objective: To estimate the consumption and quantity of unaltered antiretrivirals (ARV) eliminated into the environment and to carry out a literature research on aquatic ecotoxicological studies of ARV used in Brazil. Methodology: We requested from one of the ARV dispensing units in the city of Belo-Horizonte (BH) the amount of ARV dispensed in the years 2018-2019-2020. Considering the amount dispensed in 2020, the daily dose, and the elimination rate, the amount of drug in unchanged form in the environment was estimated. For entire municipality of BH and Brazil, we used epidemiological data were used regarding individuals using antiretroviral therapy (ART) in 2020, the proportion of people living with HIV using the main ART regimen, following the same estimation methodology used previously. Structured and individual searches were carried out for each ARV used in Brazil, relating it to ecotoxicology, through Google Scholar, National Center for Biotechnology Information and Scifinder, in addition to the use of the fass.se platform. Results: Four articles presented results of acute or chronic toxicity in ecotoxicological models involving ARV. Dolutegravir and efavirenz were found to be highly toxic in ecotoxicological models. In 2020, approximately 2,167kg of ARVs in unchanged form were released into the environment in BH. In Brazil it was 112,274kg. Conclusion: It is urgent to quantify the main ARV in water bodies. With these data together with ecotoxicological data it will be possible to establish risk criteria for possible measures to control or mitigate these contaminants in the environment, especially actions to improve wastewater/water treatment. Objetivo: Estimar el consumo y la cantidad de antirretrovirales (ARV) eliminados inalterados en el medio ambiente y realizar una búsqueda bibliográfica sobre estudios de ecotoxicología acuática de los ARV utilizados en Brasil. Metodología: Solicitamos en una de las unidades de dispensación de ARV en la ciudad de Belo-Horizonte (BH) la cantidad de ARV dispensada en los años 2018-2019-2020. Considerando la cantidad dispensada en 2020, la dosis diaria y la tasa de eliminación, se estimó la cantidad de fármaco en forma inalterada en el medio ambiente. Para todo el municipio de BH y Brasil, se utilizaron los datos epidemiológicos de las personas que utilizan la terapia antirretroviral (TARV) en 2020, la proporción de personas que viven con el HIV que utilizan el régimen principal de TARV, siguiendo la misma metodología de estimación utilizada anteriormente. Se realizaron búsquedas estructuradas e individuales para cada ARV utilizado en Brasil, relacionándolo con la ecotoxicología, a través de Google Scholar, Centro Nacional de Información Biotecnológica y Scifinder, además del uso de la plataforma fass.se. Resultados: Cuatro artículos presentaron resultados de toxicidad aguda o crónica en modelos ecotoxicológicos que involucran ARV. Se encontró que dolutegravir y efavirenz son altamente tóxicos. En 2020, aproximadamente 2167kg de ARV sin cambios se liberaron al medio ambiente en BH. En Brasil fue de 112.274kg. Conclusión: Es urgente cuantificar los principales ARV en cuerpos de agua. Con estos datos, sumados a los datos ecotoxicológicos, será posible establecer criterios de riesgo para posibles medidas de control o mitigación de estos contaminantes en el medio ambiente, especialmente actuaciones para mejorar los tratamientos de aguas residuales/aguas. Objetivo: Estimar o consumo e a quantidade de antirretrovirais (ARV) eliminados inalterados no meio ambiente e realizar uma pesquisa bibliográfica sobre estudos de ecotoxicologia aquática de ARV utilizados no Brasil. Metodologia: Solicitamos em uma das unidades dispensadoras de ARV da cidade de Belo Horizonte (BH) a quantidade de ARV dispensada nos anos de 2018-2019-2020. Considerando a quantidade dispensada em 2020, a dose diária e a taxa de eliminação, foram estimadas as quantidades de fármaco na forma inalterada no ambiente. Para todo o município de BH e Brasil, foram utilizados dados epidemiológicos referentes aos indivíduos em uso de terapia antirretroviral (TARV) em 2020, a proporção de pessoas vivendo com HIV em uso do regime principal de TARV, seguindo a mesma metodologia de estimativa utilizada anteriormente. Foram realizadas buscas estruturadas e individuais para cada ARV utilizado no Brasil, relacionando-o à ecotoxicologia, por meio do Google Scholar, National Center for Biotechnology Information e Scifinder, além do uso da plataforma fass.se. Resultados: Quatro artigos apresentaram resultados de toxicidade aguda ou crônica em modelos ecotoxicológicos envolvendo ARV. Dolutegravir e efavirenz foram considerados altamente tóxicos. Em 2020, aproximadamente 2.167kg de ARV na forma inalterada foram liberados no meio ambiente em BH. No Brasil foram 112.274kg. Conclusão: É urgente quantificar os principais ARV em corpos d'água. Com esses dados, somados aos dados ecotoxicológicos será possível estabelecer critérios de risco para possíveis medidas de controle ou mitigação desses contaminantes no meio ambiente, especialmente ações de melhoria nos tratamentos de esgoto/águas.

Tenofovir disoproxil fumarate is a prodrug, i.e. inative substance converted in vivo, after absorption to the active form deesterified tenofovir, which acts as an inhibitor of viral reverse transcriptase. To better understand the toxic effects of these drugs in the environment, three organisms were tested, the effective concentration (EC50) and inhibitory concentration (IC50) of tenofovir disoproxil that resulted in 50% growth inhibition of Microcystis novacekii, 50% immobilization of Artemia salina, and 50% loss of bioluminescence of Aliivibrio fischeri were evaluated. The EC50 value after 96 h of treatment for the cyanobacterium was 161.01 (156.81 - 165.21) mg·L-1; the IC50 value for A. salina after 24 h of treatment was 111.82 (103.18 - 120.45) mg·L-1; and the IC50 at 15 min for A. fischeri was 14.83 (13.87 - 15.79) mg·L-1. The test organism most sensitive to the drug was A. fischeri, indicating the importance of using representative models at different trophic levels to assess the potential risk of drugs for environmental toxicity. These results highlight the possible effect of tenofovir disoproxil on decomposer organisms, which may contribute to the environmental persistence of this drug.

Visceral leishmaniasis (VL) is a vector-borne disease that is caused by the protozoan Leishmania infantum and transmitted to humans and other mammals through the bites of infected female sandflies. VL has been prevalent in Minas Gerais, Brazil, since the 1940s. As the vector completes its reproductive cycle in the soil with organic matter, the association between the occurrence of VL and unimproved solid waste disposal sites has been investigated. Thus, in this study, we analyzed the relationship of waste disposal conditions, inadequacies in disposal, and waste collection with the rates of VL, using statistical regression models. A case-control study was conducted to elucidate the relationship between VL and waste management; sick individuals (cases) were compared to healthy individuals (control), to determine the cause, by constructing a multiple regression model to analyze data through a stepwise method. In Minas Gerais, according to the reports of the government in 2017, 60.1% of the urban population has access to an adequate final disposal system for urban solid waste, with an increase of 2.3% compared to the size of the disposal system in 2016. Thus, almost 40% of the population is forced to use poor or unimproved waste disposal sites. The results confirmed the direct relationship between VL and the unimproved disposal of solid waste in the municipalities (waste coverage collection: p = 0.004; waste found in the streets: p = 9.69 × 10–13). These rates also indicated that the proper management of wastes can help to combat VL by considerably reducing the breeding sites of sandflies, curbing adverse health effects, and improving the health of the population.

Some healthcare waste presents hazardousness characteristics and requires specific procedures to ensure the safety management. Waste segregation is an important action to control the risks of each type of waste. Healthcare waste indicators also may improve the waste management system. The aim of this article was to evaluate the healthcare waste management in a Brazilian university hospital, as well as the waste indicators, quantifying and qualifying the waste generation. Weighing of wastes occurred by sampling occurred sampling of seven consecutive days or daily, between 2011 and 2017. General wastes represent more than 55.6% of the total generated, followed by infectious, sharps and chemicals wastes, respectively, 39.1%, 2.9% and 2.4%. The generation rate in 2017 was 4.09 kg bed−1 day−1, including all types of wastes. Non-dangerous wastes represented around 93.3%, including infectious wastes with low potential risks, while dangerous was represented by high infectious risk (1.4%), chemicals (2.4%) and sharps (2.9%). Healthcare waste indicators may favour the risk identification and improve the waste management system, in particular when involving hazardous wastes. Failures in healthcare waste segregation could represent, in addition to the health risks, unnecessary expenses.

Background The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide. Methods Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney’s criteria, and evaluated for quality and bias verified with a funnel plot. Results After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10–0.20), and hepatitis C was 0.08 (95% CI 0.04–0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates. Conclusion The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers.

COVID-19 is a new coronavirus respiratory disease caused by SARS-CoV-2, first described in China in December 2019 and since March 2020 has been affecting the whole world. The principal mode of transmission is through exposure to respiratory droplets carrying infectious virus. Contact with contaminated surfaces or objects (fomites) is also possible, although the risk is generally considered low. However, the widespread community viral transmission makes it difficult to experimentally demonstrate human contagion via fomites. As human coronaviruses can be found on inanimate surfaces for hours up to days (depending on the inoculum shed), in materials as metal, glass or plastic, waste management can pose a problem in the context of the spread of the disease. Thus, the main objective of this work was to discuss the influence of poor waste management for the spread of SARS-CoV-2 in the state of Minas Gerais, Brazil, based on the first reported cases in 853 cities. Therefore, different variables related to socioeconomic data, waste management services, and number of COVID-19 confirmed cases were correlated and discussed. Overall, the associations found in this study in relation to reported cases and poor waste management raise the need for attention to this issue, which is still little explored despite being potentially aggravating for numerous diseases.

Wastes generated in healthcare facilities have been discussed and the World Health Organization has proposed a guideline for controlling the spread of the virus that causes Coronavirus Disease 2019 (COVID-19). However, waste management outside the generating facility should be discussed in more detail, taking into account factors such as virus resistance, differences in waste management systems and the climatic conditions in each affected region. Patients infected by human coronavirus being treated at home are generating infected waste possibly discarded as domestic waste, which can pose risks to workers and the environment, depending on the conditions of transport and disposal. In particular, the spread of the coronavirus may be increased by inadequate waste management, highlighting poor handling conditions associated with inappropriate use of personal protective equipment and other unfavourable conditions presented mainly in developing countries.

A toxicidade aquática de ingredientes ativos farmacêuticos (IFAs) e medicamentos é pouco explorada na literatura. A nevirapina (NVP) é um antirretroviral, inibidor não nucleosídeo da enzima transcriptase reversa. Este estudo avaliou a toxicidade aquática desse IFA isolado e como um medicamento à base de NVP. Para isso, foram analisados os efeitos sobre a viabilidade dos organismos aquáticos Chlorella vulgaris, Artemia salina e Aliivibrio fischeri. Foram aplicados os testes de inibição do crescimento por 72 h para a microalga C. vulgaris, de mortalidade por 24 h para o microcrustáceo A. salina e o de inibição da bioluminescência por 15 min para a bactéria A. fischeri. O modelo estatístico de dose-resposta não paramétrico log-logístico foi utilizado para obter as concentrações efetivas (CE) de 50% e 10% para a NVP isolada e para o medicamento. Constatou-se que a NVP isolada afetou a viabilidade das três espécies estudadas, porém, o medicamento à base de NVP não foi tóxico para A. salina. Ressalta-se que a CE50% de NVP diferiu estatisticamente entre o IFA e o medicamento para A. fischeri e A. salina. Observou-se também que há uma estreita faixa de concentração entre o aparecimento dos primeiros efeitos observáveis e dos efeitos tóxicos de NVP nessas espécies. Isso reforça a importância do estudo e do controle de lançamento desse IFA no ambiente. Por fim, concluiu-se que é possível implementar o monitoramento da toxicidade ambiental de micropoluentes na rotina industrial, utilizando testes de toxicidade padronizados e economicamente acessíveis, que oferecem rapidez e praticidade na análise de efluentes.

Neste texto relatamos uma atividade de Júri Simulado envolvendo aspectos sociais e ambientais relacionados a catadores de materiais recicláveis que atuam em um lixão. Esta atividade foi desenvolvida durante a disciplina Saneamento Ambiental do curso de Ciências Socioambientais de uma universidade localizada no Estado de Minas Gerais. A turma era composta por 43 alunos, que foram divididos em nove grupos com diferentes papéis durante o debate, incluindo defesa, acusação, sociedade civil organizada e jurados. Durante a atividade, foram levantados diversos elementos que demonstraram a urgência de evitar que os catadores continuem trabalhando nas condições inapropriadas do lixão, desta forma, os grupos concordaram com um Termo de Ajustamento de Conduta para que a prefeitura, com o apoio de outros atores, consiga fornecer melhores condições de trabalho para os catadores. A atividade permitiu que os participantes percebessem a posição de outros papéis, assim como a complexidade da situação tratada, sendo uma oportunidade de experimentar uma situação bastante real que estes profissionais podem se deparar no exercício profissional.

Minas Gerais is one of the 27 federative units of Brazil; it is the fourth state with the largest territorial area and the second in number of inhabitants. Since 1997, the monitoring of the surface water quality of the State of Minas Gerais has been carried out. In this study, generalized regression models were constructed to determine the correlation between the Water Quality Index (WQI) and the sanitary and socioeconomic variables: Municipal Population, Human Development Index (HDI), Gini Index, Percentage of Vulnerables to Poverty (Poverty), Monthly Per Capita Income, Percentage of Inadequate or Poor Sanitation. In addition to the sanitary and socioeconomic variables listed, it also used year of water quality monitoring, altitude of the monitoring point, and distance from the monitoring point to the urban center of the municipality. The results from the generalized models showed that the variables year, altitude, Gini Index, monthly per capita income, and poor sanitation variables were positively associated with WQI. In other words, high values of each variable increased WQI, while population variables HDI and poverty were negatively related to WQI, that is, a high population value, HDI, or poverty implies a low WQI value. Socioeconomic variables such as HDI, Gini Index, poorness, or poor sanitation percentage present the coefficients with the largest modulus. Thus, among the socioeconomic variables studied, these are the ones that most contribute to the variability of WQI. The year and altitude variables have positive regression coefficients, indicating that when these variables increase, WQI also increases. The positive correlation with the year shows that the surface water quality of Minas Gerais improved during the monitoring years.

Neste texto relatamos uma ação de Júri Simulado desenvolvido durante uma disciplina de Educação Ambiental de um curso de pós-graduação stricto sensu em saneamento e meio ambiente de uma instituição de ensino superior localizada em Belo Horizonte-MG. O Júri Simulado teve como tema central a situação de uma empresa de incineração envolvida em impactos ambientais e o Júri tomou importantes decisões em relação ao controle das atividades deste empreendimento, incluindo diversas visões sobre a atuação da empresa. A atividade permitiu aos participantes a oportunidade de ampliar os conhecimentos sobre o tema em discussão, além de exercitar a compreensão sobre a complexidade de tomadas de decisões em situações de divergência, sendo, portanto, uma ação relevante de educação ambiental para o ensino superior. This paper is related to a Simulated Jury academic action developed during an Environmental Education module of a stricto sensu postgraduate course in sanitation and environment of a higher education institution located in Belo Horizonte-MG. The Simulated Jury had the central theme about an incineration company involved with environmental impacts and the Jury took important decisions regarding the control of the activities of this undertaking, including several views on an update of the company. The activity allowed participants to increase their knowledge on the topic discussed, as well as to exercise an understanding of the complexity of decision-making in situations of divergence, and, therefore, a relevant action of environmental education for higher education. En este texto relatamos una acción de Jurado Simulado desarrollado durante una disciplina de Educación Ambiental de un curso de postgrado stricto sensu en saneamiento y medio ambiente de una institución de enseñanza superior ubicada en Belo Horizonte-MG. El Jurado Simulado tuvo como tema central la situación de una empresa de incineración involucrada en impactos ambientales y el Jurado tomó importantes decisiones en relación al control de las actividades de este emprendimiento, incluyendo diversas visiones sobre la actuación de la empresa. La actividad permitió a los participantes la oportunidad de ampliar los conocimientos sobre el tema en discusión, además de ejercitar la comprensión sobre la complejidad de tomas de decisiones en situaciones de divergencia, siendo, por lo tanto, una acción relevante de educación ambiental para la enseñanza superior.

O Antropoceno permite percebermos a influência humana no planeta e indica a necessidade de tomar atitudes reais em prol de questões socioambientais, como o acesso à água, que envolve a disponibilidade física e fatores condicionantes de origem política, econômica ou social. Neste texto, trataremos do acesso à água e como este é determinante para a saúde e bem-estar, dependendo da conservação ambiental. Dois desafios - refugiados climáticos e aprendizagem social - serão apresentados como questões relevantes para a discussão sobre o planejamento de consumo de água em longo prazo. Pretendemos demonstrar que a participação, corresponsabilidade e diálogo são essenciais para que as arenas já construídas, como os Comitês de Bacia Hidrográficas, sejam de fato plenários de discussão e ambiente propício para uma gestão hídrica para um melhor compartilhamento deste recurso limitado.

Healthcare waste (HCW) management represents a big challenge for managers around the world. Segregation is a fundamental action to allow the risk management inherent to each type of wastes. HCW indicators may favour the understanding of the waste management system status. The aim of this paper is to evaluate the HCW indicators applied in a Brazilian public institution, seeking to improve the management system and suggesting methods of applying this tool as an alternative of continuous improvement to the management process. Wastes were weighed every trimester for seven consecutive days, between of 2012 to 2017. The data represent daily, monthly and quarterly averages of the waste generated. Group B (chemical) and Group E (sharps) indicators had statistical non-significant data, suggesting very distant results from the stipulated goal. The generation rate was 355.3–500.7 kg.day−1 including all types of waste. Considering the approximate values of the non-infected wastes, which may be discarded in a landfill, the percentage represents about 75% of all HCW generated. The other 25% need to be treated at cost of $US0.76kg−1. An effectively dangerous portion of the infectious waste would be approximately 6%. Failures in segregation could represent, in addition to the health risks, unnecessary expenses of the generating establishments. HCW indicators have good potential to provide adequate risk management in health service environments.

RESUMO A destinação dos resíduos de serviços de saúde (RSS) representa uma discussão ampla e polêmica, e o momento de revisão da resolução da diretoria colegiada n.º 306/2004, da Agência Nacional de Vigilância Sanitária (ANVISA), é oportuno para ampliar esse debate. Nesse contexto, este artigo buscou, por meio da revisão de publicações científicas, subsidiar escolhas que favoreçam a sustentabilidade ambiental e a proteção da saúde humana na destinação dos RSS. Foram realizadas pesquisa bibliográfica, em âmbitos nacional e internacional, e a revisão de instrumentos legais que regulam a destinação dos RSS no Brasil. As resoluções da ANVISA (n.º 306/2004) e do Conselho Nacional do Meio Ambiente (n.º 358/2005) mostram que a disposição final dos RSS do subgrupo A4 pode ser feita em local licenciado para receber RSS, sem tratamento prévio. Diversas publicações científicas apontam para a falta de evidências quanto à existência de riscos aumentados para o ambiente e à saúde humana dos RSS se comparados aos resíduos sólidos domiciliares e explicam que ambos poderiam ter destinação final com base nos mesmos requisitos. A segregação dos RSS de acordo com os riscos reais de cada grupo e no momento da geração, assim como o acondicionamento como barreira de proteção, é o procedimento mais seguro de gerenciamento de risco contra contaminações e acidentes, sobrepondo-se aos requisitos para a destinação final. A exigência de tratar previamente os resíduos do subgrupo A4 antes de serem aterrados, conforme defendem alguns, poderia resultar em desnecessária elevação dos custos do processo sem evidência de redução dos riscos envolvidos. ABSTRACT The disposal of healthcare waste (HCW) is a controversial and wide discussion, and the review of the Collegiate Directorate Resolution no. 306/2004, from the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA), a Brazilian regulation, is appropriate to increase this debate. In this context, through the review of scientific publications, this paper supports choices that promote environmental sustainability and the protection of human health during the HCW disposal process. A bibliographical research including national and international levels and a review of legal instruments about HCW management in Brazil were done. The rules of ANVISA (no. 306/2004) and National Environment Council (no. 358/2005) point out that the final disposal of HCW, specially the subgroup A4, could be done in certified place to disposal HCW, without prior treatment. Several scientific papers mention the lack of evidences about increased risks of some kinds of HCW when compared to domestic waste, and these wastes may have final disposal based on the same criteria. Segregation of the HCW according to the real risks of each group at the moment of the generation of waste, as well as the packaging as a protective barrier, configures a safer risk management procedures against contamination and accidents. The requirement to treat the A4 subgroup before landfill disposal, as argue by some researchers, could represent an increase of unnecessary economical costs without evidences of risk reduction.

Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.

A escolha da melhor alternativa para destinacao final do lodo gerado em estacoes de tratamento de esgoto (ETE) e uma decisao complexa e conflitante. As variaveis que envolvem os processos abrangem aspectos tecnicos, economicos, ambientais e legais, que ultrapassam os limites da estacao de tratamento e cujo conhecimento e de extrema relevância para uma decisao adequada e viavel. Este trabalho pretende apresentar uma proposta de questionario que objetiva diagnosticar a situacao de ETEs, a partir de uma revisao de literatura, e abordar os principais criterios de avaliacao de alternativas para a destinacao final do lodo de esgoto. Espera-se possibilitar uma analise previa de solucoes mais adequadas, compativeis com as expectativas e objetivos de gestores em empresas publicas ou privadas de saneamento, auxiliando-os nas tomadas de decisao. O questionario elaborado foi submetido a tres profissionais tecnicos da area de saneamento, para testar sua compreensao e funcionalidade. De acordo com a analise destes tecnicos, foram implementadas melhorias no questionario, tornando-o apropriado para o objetivo proposto.