Socio Environmental and Haematological Profile of 2 Landfill Residents ( São Jorge Landfill – Sao Paulo – 3 Brazil ) 4

We are experiencing an unprecedented urbanization process that alongside with 23 physical, social and economic developments is having a significant impact on population’s health. 24 Due to higher apprehensions of pollution, violence and poverty, our modern cities no longer 25 ensure a good quality of life so they become unhealthy environments. This study aims to measure 26 the socio-environmental and hematologic profile of residents of Santo André’s landfill – “Bairro 27 Espírito Santo” by using the contextualization of the studied area. The research method is 28 Observational type and from Retrospective cohort and by convenience sampling in Santo André in 29 the Greater ABC region. The study determined a socio environmental profile and the hematologic 30 diseases screening related to a close location to the landfill. The disease manifests itself within a 31 broad spectrum of symptoms that causes changes in blood count parameters. The full blood counts 32 analysis was performed, indicating that the blood counts of residents living near the landfill led to 33 positive hematological changes and diseases like Leukopenia, Anemia, Neutropenia and 34 lymphocytosis were the most common changes. However it is considered that the proof of the 35 relation of causeeffect to environmental exposures that may trigger chronic manifestations in 36 humans requires specific studies that are often complicated. 37


Introduction
Nowadays due to higher apprehensions of pollution, violence and poverty, cities no longer ensure a good quality of life and become unhealthy environments to the local inhabitants 1 .An unprecedented urbanization in our history, alongside with physical, social and economic developments is having a significant impact on population's health 1,2 .
Alongside the continuous demographic growth there is an implicit relation with the amount of resources that have to be consumed in order to sustain all Earth citizens.Therefore it recognized a larger waste production what invariably affects a group of society dynamics.
Landfill deposition still remains as the main destination concerning waste management and it is expectable that it will remain for the next decades 3,4,5 .It is estimated that at a worldwide scale more than five million people die every year due to diseases related to waste 2 .The adverse effects of municipal solid waste in the environment plus in public and individual health are widely recognized by several authors 6 that point out a deficiency in the implemented systems and above it the lack of a strong policy that emphasizes health safeguard 7 .
The large amount of waste was not a concern from an extensive period due to the distance of deposition sites to the urban areas.Meanwhile with the population growth it has been harsh to soothe the distance among them 8 .Another arising problem connected to population growth is the unsystematic occupation of dwellings in hazardous locations and quite vulnerable environmental areas, where several are devoid of urban infrastructure (sanitation, electricity), among others 9,10 .
It is scientifically proven that there are several impacts arising from landfill positioning whether to population's health either to environment and air, water and soil pollution are the leading ones that may affect Public Health.According to this way of thinking waste and its adequate treatment and deposition became one of the major sanitary and environmental concerns to cities 3,11,12 .
The Environmental degradation scenario is unquestionable and there is a lack of policies so that the crisis can be reverted.The analysis complexity embracing all of impacts requires studies on the various impacts of waste produced daily by the population 13,14 .It is common knowledge that the blood test can be an important tool for the evaluation of various situations, such as diagnosis and progression of hematologic diseases, detection of infectious frames and therapeutic monitoring 15 .
Therefore hemogram can guide the initial suspects supported by clinical files.It is inferred the importance of the hematologic analysis as an important diagnosis tool providing useful information for a better conduct in these cases.
It is necessary the adoption a set of measures that include politics globalization, government social efficiency and social participation growth.It is the government duty to ensure that change is possible but always sustained in clear objectives as well in results well defined and special actuation properly defined.
Surrounding the landfill of San Jorge, there are situations that show how the environment has suffered impacts either in looks either physical or social 19,20 .The landfill began to operate in the 80s and it is located in São Jorge District.Santo André's landfill is a facility that provides treatment and disposal of solid waste produced in the county.Therefore it evolved from a non official dumping location to a controlled one with good environmental practices.Nowadays it is an area destined to receive solid waste produced in Santo André and provide the most suitable and green destination to the waste.
The present study aims to assess the socio-environmental profile of residents in the landfill in a residential area of Santo André -Bairro Espírito Santo.This field work will allow a better urban planning and a greater social and environmental responsibility from all sectors in society.

Method
The research method is an observational with retrospective cohort study by convenience sampling in Santo André in the Greater ABC region.The study consists of the elaboration of a socio environmental profile and assessing the incidence and prevalence of hematological diseases related not only the condition of housing but also to exposure to environmental contaminants from the landfill.The study must be understood as a primary tracking diagnosis and it will be the kick off about a transversal study to Espírito Santo inhabitants that will be performed in a near future.
The exposed group lives in the surroundings of the landfill.There is a total unawareness of the reality of this people due to the fact that national entities do not have permission to enter in order to study and help this community.Furthermore this study got a special permit to develop a campaign in being the spinoff of a more transversal study.The community habits a place that was a dumping place and actually it is the contiguous to the landfill; therefore the study aim was to establish connections among the location and the community's health.
The study was conducted in two phases.The first phase consisted of a survey and research profile of the residents as the following variables: age, gender, type of house, water treatment, water supply and type of sewage, based on interviews and completing a questionnaire.The second phase consisted of the collection of blood samples into two distinct groups: a group of people living in the community (experimental group) and a group of random people attending a health facility located in central city (control group).
According to the data obtained a descriptive and comparative analysis of the changes in hematologic patterns among both groups.
The blood samples were performed through periferic venopucntion using the vacuum method.
After recovery the blood was added to the tube with EDTA.The samples were homogeneized for 10 minutes and evaluated through flux citometry with the ABX Pentra 120 equipment.The serial evaluations were performed in blades using the Leishman method in order to obtain the procedures approached.The analysis occurred according to the Good Biomedical Practices.
The questionnaires that contained any mistake or not properly filled in were excluded in order to have viable data.The questionnaire was in Semasa database and it was performed according to internal and national regulations.
In order to verify the investigation hypothesis the Qui-Square method and Fischer's exact test were performed.The statistical interpretation was executed based on a significance level of p ≤0, 05 for a confidence interval of 95%.The non observation of the presupposes for the proper use of Qui Square results in an descriptive analysis of the crossed tables (N> 20; 80Feq≥5 e Femin≥1,0).
The sample was only gathered after the theme enlightening and only the authorization of the individuals.The anonymity was guaranteed as well as the confidentiality of the data obtained.
The tools used were the application of questionnaires and the blood counts in order to correlate the socio environmental conditions with hematologic changes.
All subjects gave their informed consent for inclusion before they participated in the study.The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Secretária Municipal de Saúde, Santo André (1.587.630).

First Phase
Questionnaires were distributed with the purpose of establishing a profile of the socio biographic towards location.In table 1 the most significant variables of the community.Of the several variables that were incorporated in the study and tabulated the appropriate statistical program, mentioned above are the best way of mirroring the social and demographic landscape of the target population.It is important to note that the variable "Sanitation" existing in table 1 corresponds to the presence of the official network of water, sewage and electricity.
As can be seen by observing Table 1 there is a female predominance and the age groups of 19 to 30 and 31 to 50 are the most prevalent in respondents.There is also a level of low income, the lack of a significant relation to the existence of sanitation difference.It was also verified that the income was inferior to 2 Minimum wages (M.W.) and it evidences that we face a special group in terms of economic capacity.It is also noted that there is a prevalence of the brick type of houses (63,1%) and (64, 3%) of them have sewage.

Second Phase
In order to obtain plausive conclusions to the case study it was necessary to compare the effects of the convenience sampling with another group of people that were not exposed to several and harmful environmental factors (Non Exposed Group) towards to the one's exposed (Exposed Group).
Of the 84 people individuals' described in table 1, 32 were randomly chosen and were designed as "Exposed Group".The Non-Exposed Group was interviewed at the same time as they did the blood sample.In total were interviewed 30 people which will correspond to the amount of blood samples.
As described earlier , so the importance of the two groups share the same characteristics , it appears that the percentages are significantly similar , where the female is the most prevalent, with 75 % in the " Group Exposed " and 66.7 % in " unexposed group " .
Regarding the age, the age range between 31-50 years was the most commonly reported, with According to the variables analysis i tis observed that both groups have significant association to the variables sewage (p=0,004) house type (p<0,0001) and Income (p=0,025) with the exception of the variables gender and age group (p>0,05).
It is noted that the totality of the individuals with sewage (82,3%) 94,4&% of them live in the surroundings of the landfill.
According to house type the totality of the non exposed live in brick houses and from the total of individuals that lives in this type (n=50) the majority (62, 5% is exposed to the landfill. The total of individuals that own an income lower than 2 M.W is 44 (71%) as 27 of them (84, 4%) is exposed to the landfill and (56,7%) correspond to the non exposed.
In order to verify the association among hematologic changes towards socio biographic characteristics the next table was prepared.(Table 3) During the analysis of the hematologic changes it was observed that there is no significant association to any variable.
Relatively to the age group variable among the age groups of 6-12 and 51-60 there is a great disparity among changes found.In an overall summit the majority (51, 6%) do not possess hematologic changes.
Regarding the sewage variable there is a balance in terms of percentages and we infer that (51,6%) does not have any hematologic changes.As regards income variable 44 individuals (71%) have an inferior income of 2 Minimum wages.
In order to investigate the existence of association among the exposure type and hematologic changes within individuals a statistical analysis was performed.The summit of results about hemograms changes is summed in table 4. The total exposed to landfill (32 cases), the majority had hematological disorders (62.5%).It was found that of 30 cases where the presence of hematological abnormalities was found, most of these are exposed to landfill (66.7%).
As noted in Table 4, there was an increase of approximately 50% for changes in screening performed in the exposed group compared to the unexposed group, which indicates that the population is not in the best health.
The chance of occurrence of hematological disorders is 3.33 times higher in subjects exposed to the presence of the landfill compared to that presented hematological changes in the unexposed group.It is recognized by the observation data, that 10 individuals from the non-exposed group showed alterations in parameters, whereas the incidence in the exposed group was significantly higher with 20 individuals to submit changes.
Diseases such as Leukocytosis, Anemia, Lymphocytosis and Neutropenia were the major findings and changes are evident in the exposed group compared to the unexposed group.

Discussion
Analyzing the changes in vital functions of living beings, it is possible to know the effects of exposure to pollutants aforementioned to its occurrence and existence of any more significant damage 16,21,22,23,24 .
It is considered that proving the cause-effect connection with environmental exposures that may trigger chronic manifestations in humans requires specific studies that prove costly and time consuming 25,26,27,28 .It is necessary that the data must be collected in the field so as to be compared with experimental observations in order to demonstrate the process and how the interactions occur so as to study the dynamics 14 .
The effects of human exposure to environmental pollutants are manifested typically in the long term and are masked by other causes.Adding to this, the fact that the probability of harmful elements synergy and exponentiation of the risk is generally unknown and there is thus extremely difficult for corroboration by a science based on laboratory tests, without incorporating other relevant factors, such as corporate interests, industrial, or professional regulators who stand against the recognition of the effects on human health 18,22,24,28 .
Given these considerations and also relying on the limitations of the health system itself in identifying peculiarities in the epidemiological profile of the population; a methodology was defined that aims the total understanding of the exposure process.There are five parameters that are difficult to materialize such as individual characteristics, duration of exposure, frequency of exposure, average time and "contact rate", never forgetting that the characteristics of the individual vary by age, gender, occupation, and body weight 29 .
The focus of the study is the exposure of individuals to organisms, as well as to social, economic and environmental processes in anticipation of models that focus historically in the monitoring and maintenance of health 19,20 .There have been published several papers that address the role that the landfill can hold on people's health 28,29,30 .There is no doubt that a landfill should be viewed from a holistic point of view, in that it must manage the direct and indirect that it may exercise near the same impact 3,16,30 .
Despite the existence of Federal Government programs for vulnerable populations, do not show an improvement of living conditions of this community 11,12 .As a tool to promote the respective indicative and screening improvements to minimize ongoing risks potentiating of the CBC taking into account all capabilities of this method of monitoring.CBC integrates a set of parameters that describes the number and characteristics of some elements in the blood.The CBC is composed of three basic determinations include (or red series), leukocytes (white or series) Review of erythrocytes and platelets (platelet or series) 31 .
The lymphocytosis is characterized by an increase in the number of lymphocytes (sub-group of white blood cells).The disease neutropenia indicates a low number of neutrophils that are a subset of leukocytes that originate in the bone marrow, thus revealing an immune susceptibility.The increase of leukocytes is a sign of a viral infection, i.e. near the landfill people tend not to viral and bacterial infections 31 .The disease leukocytosis reveals an increased number of leukocytes that reveals the existence of infection since they are the elements that are linked to fighting immune system to foreign bodies.The higher leukocytosis, may be more contaminated landfill, can be interpreted as a parameter to reveal deepening to establish causal links.The disease of anemia is more complex, so the causes are more comprehensive and diversified, which immediately implies a more detailed investigation into these cases 31,32,33 .
The Lymphocytosis, Neutropenia and Leukocytosis diseases can be understood as correlated despite having opposite directions of growth, as previously conveyed 33 .
The results express the presence of discrepancies in the health of the Holy Ghost Quarter population, compared with the other subjects in the study, which requires the completion of further studies detect the most common causes and the consequences for the residents of order to enable the development of a continuous and systematic supervision for the same programs.It is suggested that in-depth study for potential replacement of the group under study so that based on the results of this study primary health problems resulting from exposure were identified in comparison with the non-treatment group.
The problems derived from municipal solid waste are current and without a proper equation 34 .
There is no alternative but to a behavioral change in relation to waste, given the reduction in its creation and gradually implement a use of technologies that are within our technical capabilities and leverage resources to gradually acquire greater control over the environmental and health effects caused by waste. (35)prevention and control of public health consequences related to urban solid waste lack of information and epidemiological data, in which causal relationships can be established.There is a colossal deficiency in studies on the recovery of degraded areas for disposal of urban solid waste.In this context, this article seeks to contribute to a consolidation of the state of art related to the theme, in order to contribute to awareness of the elements aimed at improving the quality of urban cities and hence the quality of life of citizens 29,34 .
The supporting research of this kind is a priority.The development of greater technical training, in view of the environmental and health issues, as well as the involvement of professionals in integrated waste management systems, in the medium and long term, these variables enter in projects and plans 13,35,36 .
Data from this study should be compared with other data, may involve a characterization of the epigenetic profile of the population 37 and to a characterization of the study areas for the presence of particulate material 38 .The challenge is to continue collecting more valid and reliable data in order to achieve an extrapolation between environmental and respective consequences for the health of population's risk factors to make a comparison to a national and global scale. (16)The study described is the first step in a thorough all the Espírito Santo community study.
The data obtained in this study indicate that screening strategies for prevention and health promotion should include joint actions established between citizens and the management of services and always aimed at improving living conditions, particularly targeted to urban planning, implementation educational programs, as well as awareness for behavior change, once isolated actions are considered ineffective in reducing any aggravation [36][37][38][39] .
It can be inferred that this study has a purpose of consolidating knowledge which contribute to the prevention and detection of known and unknown to the public and environmental exposure-related adverse health effects 38,39 .The study should be understood as a primary screening indication of some pathologies.In addition to being able to assess the state of health of the patient may be indicative of the state of pollution of landfill insofar as the conditions are reflected in the landfill people.
We must identify priorities at the community level, so that the understanding of environmental health problems is essential.Sustainable planning is a tool for achieving proceeds with an implementation of a research-oriented future intervention, and thus addresses the issues of greatest importance.However, this process is not simple in communities characterized by persistent health disparities and a lack of historical confidence in health professionals 38,39 .
The primary findings, based on elaborate study were anemia, leukocytosis, Lymphocytosis and Neutropenia.These data show this to be a group with greater immune susceptibility, adding that some elements of the exposed already have infections that are consistent with exposure to contaminants, supporting the existence of a pattern.Aiming at the promotion of Health suggests the continuity of the project monitoring, in order to obtain a greater number of clairvoyance that support the trace output made and described.
Based on the study, the exposed group has 3.33 times more likely to develop hematological abnormalities, with reference to its exposure to the landfill with the group that was not exposed.
Although the results show only the Holy Spirit occurred in the neighborhood, in the Greater ABC region also provide important information for the expansion of knowledge concerning the assessment of this risk in residential areas around the planet clues.The demand for a thorough investigation is urgent with a view to broadening and disseminating information related to the potential effects of human exposure to contaminants from multiple sources that affect public health.
Future investigations may include concepts like the Nano Particles and the term Epigenetics, in order to promote a holistic view of the causes, mechanisms and consequences that flow from human to a multitude of organism's exposure, thus completing the present study and scientific knowledge, thus eliminating cross existing limitations.

Conclusion
The full blood counts analysis was performed and it was discovered that the blood counts of residents living near the landfill had positive results in hematological changes and diseases like Leukopenia, Anemia, Neutropenia and lymphocytosis were the most frequently encountered changes.However it is considered that the proof of the relation of cause-effect to environmental exposures that may trigger chronic manifestations in humans requires specific studies that are often costly and time-consuming.

4 October 2016 doi:10.20944/preprints201610.0005.v1Table 2 .
Association of the socio biographic characteristics with the exposition type Regarding the "Non-exposed group" it is observable a greater purchasing power, and therefore all of the respondents live in brick houses and nearly all have sanitation.In the table 2 it is described the exposure type according to socio biographic characteristics.Preprints (www.preprints.org)| NOT PEER-REVIEWED | Posted:

Table 4 .
Relation among exposure type with hematologic change