Controlo Microbiológico do Ar e Superfícies em Unidades de Prestação de Cuidados de Saúde

O controlo ambiental deverá garantir a adequada qualidade microbiológica do ar e superfícies nas unidades de saúde possibilitando a redução das infecções associadas, tanto nos utentes como nos colaboradores. A presente comunicação refere as principais fontes de contaminação ambiental a considerar, a metodologia de avaliação de risco e o estabelecimento de valores guia para os controlos do ar e superfícies.

Primeiro Inquérito Nacional de Saúde com Exame Físico: relatório metodológico

O primeiro INSEF realizado em Portugal é promovido e coordenado pelo Instituto Ricardo Jorge através do seu Departamento de Epidemiologia, em parceria com o Instituto Norueguês de Saúde Publica e em colaboração com as Administrações Regionais de Saúde do Continente e Secretarias Regionais de Saúde das Regiões Autónomas dos Açores e da Madeira.

Escovagem de dentes em ambiente escolar e redução do índice de placa bacteriana: avaliação da efetividade de um projeto de saúde oral

Dada a elevada prevalência de cárie em Portugal em idades jovens, a equipa de saúde escolar do concelho de Oliveira do Bairro (distrito de Aveiro), desenvolveu, durante o ano letivo 2012/13, um projeto de educação para a saúde, denominado Senhor Dente, dirigido a crianças em idade pré‐escolar (3‐6 anos) que consistiu na implementação da escovagem na escola. Com este estudo pretendeu‐se determinar o grau de redução da placa bacteriana nas crianças abrangidas pelo referido projeto, de forma a avaliar a sua efetividade na redução das cáries dentárias. Efetuou‐se um estudo quasi experimental, no qual foi avaliado o índice de placa bacteriana individual antes e após a implementação do projeto (ninicial = 256; nfinal = 190). Antes da intervenção, estimou‐se uma prevalência de cárie dentária de 32,8% (IC 95%: 27,0‐38,6). Após a implementação da escovagem dentária na escola, observou‐se uma redução do índice de placa bacteriana de 2,45 (IC 95%: 2,38‐2,51), havendo uma associação estatisticamente significativa entre a variação no índice de placa bacteriana e o valor inicial do índice de dentes cariados, perdidos e obturados por cárie e, também, com o intervalo de tempo decorrido entre os 2 momentos de avaliação. Os resultados demonstraram a efetividade dos programas de saúde escolar que promovam a escovagem dentária diária na escola e sugerem a necessidade de avaliar qual deve ser a duração destes projetos, como forma de otimizar os recursos necessários para o seu desenvolvimento.

Riscos laborais associados à manipulação de nanomateriais

De um modo geral, os nanomateriais manufaturados (NM) são definidos como materiais fabricados deliberadamente e que contêm partículas com pelo menos uma dimensão externa na gama de tamanhos compreendida entre 1 e 100 nanómetros (Comissão Europeia, 2011). A sua pequena dimensão confere-lhes propriedades físicas, químicas e biológicas que podem diferir bastante das propriedades dos materiais com a mesma composição química mas utilizados numa escala não nanométrica. São as propriedades mecânicas, óticas, elétricas e magnéticas inerentes aos materiais na escala “nano” que os tornam vantajosos para as mais diversas aplicações industriais e biomédicas. Contudo, a enorme expansão que tem vindo a acontecer ao nível da síntese, produção industrial e utilização de NMs contrasta com uma ainda insuficiente avaliação de risco para a saúde humana e para o ambiente. Efectivamente, A European Agency for Safety and Health at Work (EU-OSHA,2009) considerou a exposição a NM como o risco emergente mais premente no contexto da saúde ocupacional, estimando que entre 300.000 a 400.000 postos de trabalho lidavam já directamente com as nanotecnologias. Neste seminário será abordada a possibilidade de exposição ocupacional ao longo do ciclo de vida dos NM, bem como as suas potenciais implicações para a saúde dos trabalhadores. Nesta palestra são apresentados alguns estudos realizados no Instituto Nacional de Saúde Doutor Ricardo Jorge que produziram evidência científica que poderá contribuir para o esforço internacional da regulação da produção e aplicação de nanomateriais, salvaguardando a saúde humana face às suas aplicações inovadoras.

Air fungal contamination in ten hospitals’ food units from Lisbon

A descriptive study was developed to monitor air fungal contamination in ten food units from hospitals. Fifty air samples of 250 litres were collected through impaction method. Samples were collected in food storage facilities, kitchen, food plating, canteen and also, outside premises, since this is the place regarded as reference. Simultaneously, environmental parameters were also monitored, including temperature and relative humidity through the equipment Babouc, LSI Sistems and according to the International Standard ISO 7726.

Firefighters' exposure biomonitoring: Impact of firefighting activities on levels of urinary monohydroxyl metabolites

The concentrations of six urinary monohydroxyl metabolites (OH-PAHs) of polycyclic aromatic hydrocarbons, namely 1-hydroxynaphthalene, 1-hydroxyacenaphthene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene (1OHPy), and 3-hydroxybenzo[a]pyrene, were assessed in the post-shift urine of wildland firefighters involved in fire combat activities at six Portuguese fire corporations, and compared with those of non-exposed subjects. Overall, median levels of urinary individual and total OH-PAHs (ΣOH-PAHs) suggest an increased exposure to polycyclic aromatic hydrocarbons during firefighting activities with ΣOH-PAH levels in exposed firefighters 1.7-35 times higher than in non-exposed ones. Urinary 1-hydroxynaphthalene and/or 1-hydroxyacenapthene were the predominant compounds, representing 63-98% of ΣOH-PAHs, followed by 2-hydroxyfluorene (1-17%), 1-hydroxyphenanthrene (1-13%), and 1OHPy (0.3-10%). A similar profile was observed when gender discrimination was considered. Participation in fire combat activities promoted an increase of the distribution percentage of 1-hydroxynaphthalene and 1-hydroxyacenaphthene, while contributions of 1-hydroxyphenanthrene and 1OHPy decreased. The detected urinary 1OHPy concentrations (1.73×10(-2) to 0.152μmol/mol creatinine in exposed subjects versus 1.21×10(-2) to 5.44×10(-2)μmol/mol creatinine in non-exposed individuals) were lower than the benchmark level (0.5μmol/mol creatinine) proposed by the American Conference of Governmental Industrial Hygienists. This compound, considered the biomarker of exposure to PAHs, was the less abundant one from the six analyzed biomarkers. Thus the inclusion of other metabolites, in addition to 1OHPy, in future studies is suggested to better estimate firefighters' occupational exposure to PAHs. Moreover, strong to moderate Spearman correlations were observed between individual compounds and ΣOH-PAHs corroborating the prevalence of an emission source.

A cost-efficiency and health benefit approach to improve urban air quality

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored.

Children exposure to indoor ultrafine particles in urban and rural school environments

Extended exposure to ultrafine particles (UFPs) may lead to consequences in children due to their increased susceptibility when compared to older individuals. Since children spend in average 8 h/day in primary schools, assessing the number concentrations of UFPs in these institutions is important in order to evaluate the health risk for children in primary schools caused by indoor air pollution. Thus, the purpose of this study was to assess and determine the sources of indoor UFP number concentrations in urban and rural Portuguese primary schools. Indoor and outdoor ultrafine particle (UFP) number concentrations were measured in six urban schools (US) and two rural schools (RS) located in the north of Portugal, during the heating season. The mean number concentrations of indoor UFPs were significantly higher in urban schools than in rural ones (10.4 × 10(3) and 5.7 × 10(3) pt/cm(3), respectively). Higher UFP levels were associated with higher squared meters per student, floor levels closer to the ground, chalk boards, furniture or floor covering materials made of wood and windows with double-glazing. Indoor number concentrations of ultrafine-particles were inversely correlated with indoor CO2 levels. In the present work, indoor and outdoor concentrations of UFPs in public primary schools located in urban and rural areas were assessed, and the main sources were identified for each environment. The results not only showed that UFP pollution is present in augmented concentrations in US when compared to RS but also revealed some classroom/school characteristics that influence the concentrations of UFPs in primary schools.

Polycyclic aromatic hydrocarbons at fire stations: firefighters’ exposure monitoring and biomonitoring, and assessment of the contribution to total internal dose

This work characterizes levels of eighteen polycyclic aromatic hydrocarbons (PAHs) in the breathing air zone of firefighters during their regular work shift at eight Portuguese fire stations, and the firefighters' total internal dose by six urinary monohydroxyl metabolites (OH-PAHs). Total PAHs (ΣPAHs) concentrations varied widely (46.4-428ng/m(3)), mainly due to site specificity (urban/rural) and characteristics (age and layout) of buildings. Airborne PAHs with 2-3 rings were the most abundant (63.9-95.7% ΣPAHs). Similarly, urinary 1-hydroxynaphthalene and 1-hydroxyacenaphthene were the predominant metabolites (66-96% ΣOH-PAHs). Naphthalene contributed the most to carcinogenic ΣPAHs (39.4-78.1%) in majority of firehouses; benzo[a]pyrene, the marker of carcinogenic PAHs, accounted with 1.5-10%. Statistically positive significant correlations (r≥0.733, p≤0.025) were observed between ΣPAHs and urinary ΣOH-PAHs for firefighters of four fire stations suggesting that, at these sites, indoor air was their major exposure source of PAHs. Firefighter's personal exposure to PAHs at Portuguese fire stations were well below the existent occupational exposure limits. Also, the quantified concentrations of post-shift urinary 1-hydroxypyrene in all firefighters were clearly lower than the benchmark level (0.5μmol/mol) recommended by the American Conference of Governmental Industrial Hygienists.

The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto

Background: persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. Objective: to evaluate the influence of indoor air quality and contaminants on older people’s respiratory health. Design: cross-sectional study. Setting: 21 long-term care residences (LTC) in the city of Porto, Portugal. Subjects: older people living in LTC with ≥65 years old. Methods: the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. Results: cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (18%) the main selfreported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1–7.2). Conclusion: high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms.

Indoor air quality in Portuguese schools: levels and sources of pollutants

Indoor air quality (IAQ) parameters in 73 primary classrooms in Porto were examined for the purpose of assessing levels of volatile organic compounds (VOCs), aldehydes, particulate matter, ventilation rates and bioaerosols within and between schools, and potential sources. Levels of VOCs, aldehydes, PM2.5 , PM10 , bacteria and fungi, carbon dioxide (CO2 ), carbon monoxide, temperature and relative humidity were measured indoors and outdoors and a walkthrough survey was performed concurrently. Ventilation rates were derived from CO2 and occupancy data. Concentrations of CO2 exceeding 1000 ppm were often encountered, indicating poor ventilation. Most VOCs had low concentrations (median of individual species <5 μg/m(3) ) and were below the respective WHO guidelines. Concentrations of particulate matter and culturable bacteria were frequently higher than guidelines/reference values. The variability of VOCs, aldehydes, bioaerosol concentrations, and CO2 levels between schools exceeded the variability within schools. These findings indicate that IAQ problems may persist in classrooms where pollutant sources exist and classrooms are poorly ventilated; source control strategies (related to building location, occupant behavior, maintenance/cleaning activities) are deemed to be the most reliable for the prevention of adverse health consequences in children in schools.

Indoor air quality in schools and its relationship with children's respiratory symptoms

A cross-sectional survey was conducted to characterize the indoor air quality (IAQ) in schools and its relationship with children's respiratory symptoms. Concentrations of volatile organic compounds (VOC), aldehydes, PM2.5, PM10, carbon dioxide, bacteria and fungi were assessed in 73 classrooms from 20 public primary schools located in Porto, Portugal. Children who attended the selected classrooms (n = 1134) were evaluated by a standardised health questionnaire completed by the legal guardians; spirometry and exhaled nitric oxide tests. The results indicated that no classrooms presented individual VOC pollutant concentrations higher than the WHO IAQ guidelines or by INDEX recommendations; while PM2.5, PM10 and bacteria levels exceeded the WHO air quality guidelines or national limit values. High levels of total VOC, acetaldehyde, PM2.5 and PM10 were associated with higher odds of wheezing in children. Thus, indoor air pollutants, some even at low exposure levels, were related with the development of respiratory symptoms. The results pointed out that it is crucial to take into account the unique characteristics of the public primary schools, to develop appropriate control strategies in order to reduce the exposure to indoor air pollutants and, therefore, to minimize the adverse health effects.

Children's health and indoor air quality in primary schools and homes in Portugal-Study design

The main aim of the research project "On the Contribution of Schools to Children's Overall Indoor Air Exposure" is to study associations between adverse health effects, namely, allergy, asthma, and respiratory symptoms, and indoor air pollutants to which children are exposed to in primary schools and homes. Specifically, this investigation reports on the design of the study and methods used for data collection within the research project and discusses factors that need to be considered when designing such a study. Further, preliminary findings concerning descriptors of selected characteristics in schools and homes, the study population, and clinical examination are presented. The research project was designed in two phases. In the first phase, 20 public primary schools were selected and a detailed inspection and indoor air quality (IAQ) measurements including volatile organic compounds (VOC), aldehydes, particulate matter (PM2.5, PM10), carbon dioxide (CO2), carbon monoxide (CO), bacteria, fungi, temperature, and relative humidity were conducted. A questionnaire survey of 1600 children of ages 8-9 years was undertaken and a lung function test, exhaled nitric oxide (eNO), and tear film stability testing were performed. The questionnaire focused on children's health and on the environment in their school and homes. One thousand and ninety-nine questionnaires were returned. In the second phase, a subsample of 68 children was enrolled for further studies, including a walk-through inspection and checklist and an extensive set of IAQ measurements in their homes. The acquired data are relevant to assess children's environmental exposures and health status.

Exposure of children to ultrafine particles in primary schools in Portugal

Children spend a large part of their time at schools, which might be reflected as chronic exposure. Ultrafine particles (UFP) are generally associated with a more severe toxicity compared to fine and coarse particles, due to their ability to penetrate cell membranes. In addition, children tend to be more susceptible to UFP-mediated toxicity compared to adults, due to various factors including undeveloped immune and respiratory systems and inhalation rates. Thus, the purpose of this study was to determine indoor UFP number concentrations in Portuguese primary schools. Ultrafine particles were sampled between January and March 2014 in 10 public primary schools (35 classrooms) located in Porto, Portugal. Overall, the average indoor UFP number concentrations were not significantly different from outdoor concentrations (8.69 × 10(3) vs. 9.25 × 10(3) pt/cm(3), respectively; considering 6.5 h of indoor occupancy). Classrooms with distinct characteristics showed different trends of indoor UFP concentrations. The levels of carbon dioxide were negatively correlated with indoor UFP concentrations. Occupational density was significantly and positively correlated with UFP concentrations. Although the obtained results need to be interpreted with caution since there are no guidelines for UFP levels, special attention needs to be given to source control strategies in order to reduce major particle emissions and ensure good indoor air quality.