980 resultados para adverse effects
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The objective of this study was to investigate an association between pre-harvest sugarcane burning and respiratory diseases in children under five years of age. The following data were collected in five schools in the city of Araraquara, SP, Southeastern Brazil, between March and June 2009: daily records of absences and the reasons stated for these absences, total concentration of suspended particulate matter (g/m3), and air humidity. The relationship between the percentage of school absences due to respiratory problems and the concentration of particulate matter in March and from April to June presented a distinct behavior: absences increased alongside the increase in particulate matter concentration. The use of school absences as indicators of this relationship is an innovative approach.
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ABSTRACT OBJECTIVE To analyze the impact of air pollution on respiratory and cardiovascular morbidity of children and adults in the city of Vitoria, state of Espirito Santo. METHODS A study was carried out using time-series models via Poisson regression from hospitalization and pollutant data in Vitoria, ES, Southeastern Brazil, from 2001 to 2006. Fine particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) were tested as independent variables in simple and cumulative lags of up to five days. Temperature, humidity and variables indicating weekdays and city holidays were added as control variables in the models. RESULTS For each increment of 10 g/m3 of the pollutants PM10, SO2, and O3, the percentage of relative risk (%RR) for hospitalizations due to total respiratory diseases increased 9.67 (95%CI 11.84-7.54), 6.98 (95%CI 9.98-4.17) and 1.93 (95%CI 2.95-0.93), respectively. We found %RR = 6.60 (95%CI 9.53-3.75), %RR = 5.19 (95%CI 9.01-1.5), and %RR = 3.68 (95%CI 5.07-2.31) for respiratory diseases in children under the age of five years for PM10, SO2, and O3, respectively. Cardiovascular diseases showed a significant relationship with O3, with %RR = 2.11 (95%CI 3.18-1.06). CONCLUSIONS Respiratory diseases presented a stronger and more consistent relationship with the pollutants researched in Vitoria. A better dose-response relationship was observed when using cumulative lags in polynomial distributed lag models.
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ABSTRACT OBJECTIVE To evaluate clinical evidence on the safety and efficacy of fenproporex for treating obesity. METHODS MEDLINE, LILACS and Cochrane Controlled Trials Register were searched as well as references cited by articles and relevant documents. Two authors independently assessed the studies for inclusion and regarding risk of bias, collected data, and accuracy. Eligible studies were all those placebo-controlled that provided data on the efficacy and safety of Fenproporex to treat obesity. RESULTS Only four controlled studies met the inclusion criteria. One randomized, placebo-controlled trial on Fenproporex was found on electronic databases. Three placebo-controlled studies (in non-indexed journals) were identified by hand-searching. Patients with cardiovascular and other comorbidities were excluded in all studies. Trials lasted from 40 to 364 days and doses ranged from 20 to 33.6 mg/d. All controlled studies found that weight loss among Fenproporex-treated patients was greater than that produced by the placebo, but drug effect was modest. Fenproporex produced additional weight reductions of 4.7 kg (one year), 3.8 kg (six months) and 1.55 kg (two months) in average, in relation to diet and exercise only (three trials). Insomnia, irritability, and anxiety were the most frequently reported side effects in the four studies. CONCLUSIONS There is a paucity of randomized, placebo-controlled trials on Fenproporex and those identified here present major methodological flaws. These studies suggest that Fenproporex is modestly effective in promoting weight loss. Nonetheless, they failed to provide evidence that it reduces obesity-associated morbidity and mortality. Data from these studies are insufficient to determine the risk-benefit profile of Fenproporex. Abuse potential and amphetamine-like adverse effects are causes for concern.
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Introduo: O CPAP nasal o tratamento de eleio para os pacientes com Sndrome da Apneia Obstrutiva do Sono (SAOS). Com a mscara nasal podem ocorrer fugas de ar pela boca, que podem por em causa a aderncia do paciente ao tratamento devido muitas vezes ao desconforto que provocam, ao aumento do trabalho respiratrio e por afectarem a qualidade do sono. Objectivos: Este estudo tem como principal objectivo verificar a eficcia da banda submentoniana e da mscara facial na correco das fugas pela boca em pacientes com SAOS. Mtodos e Participantes: Uma amostra de convenincia de 15 pacientes (8 homens) com SAOS e a fazerem CPAP com mscara nasal, foi recrutada. Foram divididos em dois grupos A e B, onde no grupo A se colocou a banda submentoniana e no grupo B se alterou a interface para mscara facial. Medidas e Resultados: As variveis avaliadas neste estudo foram as fugas, o IAH, o percentil 95 da presso de tratamento, a Sa,O2 e os efeitos adversos das duas intervenes. O nvel de fugas reduziu no grupo A de 3811,27 para 24,5514,30L/min (p=0,002) e no grupo B de 34,3416,50 para 18,5116,22L/min (p=0,008). O IAH aumentou no grupo B de 2,602,13 para 4,413,88 (p=0,016). Relativamente ao percentil 95 da presso de tratamento aumentou nos dois grupos (Grupo A de 10,152,63 para 12,082,45cmH2O (p=0,008) e no Grupo B 10,511,88 para 12,641,29cmH2O (p=0,008)). A Sa,O2 mnima aumentou e o tempo<90% diminui no grupo A com p=0,008, p=0,031, respectivamente. Quanto ao uso auto-reportado verificaram-se poucos efeitos adversos, salientando-se apenas a facilidade de colocao da banda submentoniana, a secura da boca nos dois grupos, a presso no queixo provocada pela banda e a dor no dorso do nariz provocada pela mscara facial. Concluso: Ambas as estratgias provaram ser mais eficazes a reduzir a fuga que a mscara nasal. Foram bem toleradas e com poucos efeitos adversos.
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Resumo Uma estratgia de avaliao e preveno de riscos na exposio a agentes qumicos deve ter sempre em conta que a vigilncia do ambiente de trabalho e a da sade dos trabalhadores so aspectos complementares de uma mesma realidade os riscos resultantes da interaco entre um agente qumico e os trabalhadores a ele expostos. Se Vigilncia Ambiental compete apreciar o risco, pela caracterizao do agente no ambiente de trabalho, a Vigilncia Biolgica pronuncia-se sobre a interaco entre o txico e o organismo, avaliando a resposta agresso qumica e a evoluo das reaces de adaptao ou de desajuste face absoro do txico. Os Indicadores Biolgicos, deste modo, assumem um estatuto de instrumento privilegiado na vigilncia da sade dos trabalhadores expostos, na medida em que medem a quantidade de txico que efectivamente penetrou e foi absorvido, ou o resultado (efeito) determinado por essa mesma dose. O presente estudo procura contribuir para a definio de um quadro metodolgico de utilizao dos Indicadores Biolgicos na avaliao/gesto da exposio profissional ao chumbo, designadamente apreciando a variao da protoporfirina-zinco (PPZ), indicador at ao presente ainda no utilizado em Portugal. O chumbo um metal de ocorrncia natural, cujos nveis nos diversos ecossistemas resultam, principalmente, das actividades antropognicas de natureza domstica e industrial. A sua capacidade poluente assinalvel, representando uma fonte de exposio permanente para o homem, demonstrvel pela sua constante presena no organismo apesar de no desempenhar qualquer tipo de funo fisiolgica. So actualmente inmeras as suas aplicaes, tornando a exposio profissional ao chumbo uma realidade vasta: indstrias de acumuladores elctricos, de vidros, de plsticos e de munies, construo civil, manuteno e reparao automvel e de navios, fabrico de tintas, indstrias electrnicas, fundies e actividades de soldadura so, entre outras, situaes onde uma realidade a ter em conta. A penetrao dos compostos inorgnicos de chumbo no organismo efectua-se principalmente por via respiratria, no sendo, no entanto, desprezvel, a sua penetrao por via digestiva. As partculas absorvidas so transportadas pelo sangue principalmente ligadas aos eritrocitos (95%), distribuem-se pelos tecidos moles e depositam-se essencialmente no tecido sseo, onde representam mais de 90% da carga corporal do total absorvido e tendo a um elevado tempo de semi-vida (mais de 20 anos). No metabolizado no organismo e a sua eliminao efectua-se essencialmente por via renal,sendo igualmente excretado, em menor escala, atravs das fezes, do suor, da saliva, das faneras e do leite materno. O conhecimento cientfico evidencia que concentraes sanguneas de chumbo entre 20 e 50 mg/dL so susceptveis de determinar efeitos adversos no homem, podendo ser afectados o sistema hematopoitico, o sistema nervoso, o sistema cardiovascular, o sistema reprodutor e o sistema imunitrio. Contudo, ainda muito h a clarificar no mbito da toxicidade do chumbo. Os nveis de exposio a que correspondem as alteraes nos diversos rgos e sistemas continuam a ser motivo de alguma controvrsia. As caractersticas carcinognicas e mutagnicas do chumbo so, ainda, um campo de vasta exigncia de investigao. A intoxicao por chumbo e seus sais (Saturnismo) de origem ocupacional reconhecida em Portugal como doena profissional (grupo 1 - Doenas Provocadas por Agentes Qumicos, da Lista das Doenas Profissionais). uma intoxicao do tipo crnico, fruto da absoro contnua de doses relativamente pequenas durante longo perodo, evidenciando-se no seu incio por sinais e sintomas vagos e difusos de grande inespecificidade, que podem incluir, nomeadamente, perda de apetite, sabor metlico na boca, palidez, mal-estar e fadiga, cefaleias, mialgias e artralgias, irritabilidade, tremores finos, obstipao, clicas abdominais, insnias, dficit da memria de curto prazo e da capacidade de concentrao. Um importante conjunto de indicadores biolgicos pode ser utilizado na vigilncia peridica da sade de trabalhadores nestas condies de exposio. Tais indicadores (de dose ou de efeito), encerram diferentes significados e comportam distintas exigncias, competindo ao Mdico do Trabalho, no mbito dos programas de preveno dos efeitos adversos relacionados com a exposio profissional a chumbo, seleccionar a sua utilizao e interpretar a sua informao, de modo a avaliar a interaco do txico com o organismo numa fase de reversibilidade. O presente estudo envolveu 180 trabalhadores dos quais 110 apresentavam plumbmias (Pb-S) iguais ou superiores a 40 mg/dL. Alm da Pb-S, a todos foi doseada a protoporfirina-zinco (PPZ) e efectuado o Hemograma e a cerca de 25% foi determinada a concentrao do cido d-aminolevulnico urinrio (ALA-U). Os doseamentos da PPZ efectuados em amostra de sangue capilar atravs de um hematofluormetro porttil revelaram-se de total fiabilidade, dando significado a uma tcnica de fcil execuo e baixo custo. A avaliao do tipo de colheita urinria para doseamento do ALA-U concluiu pela necessidade de recurso a urinas de 24 horas.Os resultados do estudo evidenciaram uma elevada associao entre a PPZ e a Pb-S, com uma maior magnitude e de incio mais precoce do que o que registado na associao da Pb-S com o ALA-U. Revelaram, ainda, fracos nveis de associao da hemoglobina (e outros parmetros hematolgicos) com a Pb-S. E demonstraram para um cut-off de 100 mg/ dL de PPZ, taxa de falsos negativos e falsos positivos, para plumbmias a partir de 70 mg/dL, inferiores a 20%. Assim, concluiu-se que, nos protocolos de vigilncia de sade de trabalhadores expostos a chumbo, o doseamento da PPZ por hematofluormetro, em sangue de colheita capilar, adequado, fivel e de realizao preferencial em relao ao do ALA-U. Concluiu-se, tambm, que a realizao do hemograma apenas se justifica em situaes individuais que clinicamente o tornem aconselhvel. E que estes protocolos devem incluir a realizao da Pb-S e da PPZ, podendo, em situaes de controlo rigoroso (ambiental, biolgico e clnico), basear-se apenas na determinao da PPZ reservando os outros indicadores para aprofundar a investigao mdica nos casos de taxas elevadas desta ou de situaes limitantes. Rsume Une stratgie dvaluation et de prvention des risques dexposition aux agents chimiques doit toujours tenir en considration que la vigilance du lieu de travail et de la sant des travailleurs sont des aspects complmentaires dune mme ralit les risques rsultant dune interaction entre lagent chimique et les travailleurs exposs. Si cest la Vigilance Ambiantale de juger le risque, par la caractrisation de lagent dans le lieu de travail, la Vigilance Biologique, elle, se prononce sur linteraction entre le toxique et lorganisme, valuant la rponse lagression chimique et lvolution des ractions dadaptation ou de rupture face labsorption du toxique. Les Indicateurs Biologiques assument ainsi un statut dinstrument privilgi de vigilance de la sant des travailleurs exposs, dans la mesure o ils dterminent la quantit de toxique qui a effectivement t pntr et absorb, ou le rsultat (effet) dtermin par cette dose. Cette tude-ci cherche contribuer la dfinition dun cadre mthodologique dutilisation des Indicateurs Biologiques dans lvaluation/ gestion de lexposition professionnelle au plomb inorganique, valuant spcialement le comportement de la protoporphirine-zinc (PPZ), indicateur pas encore utilis au Portugal.Le plomb est un mtal doccurrence naturelle dont les niveaux dans les diffrents cosystmes en rsultent, principalement, des activits anthropogniques de nature domestique et industrielle. Sa capacit polluante peut tre signale, reprsentant une source dexposition permanente pour lhomme, celle-ci dmontrable par sa prsence continue dans lorganisme, mme si elle ny accomplit aucune fonction physiologique. Actuellement ses applications sont innombrables, faisant de lexposition professionnelle au plomb une ralit de grande ampleur : industries daccumulateurs lectriques, de verre, de plastique et de munitions, btiments, manutention et rparation automobile et navale, fabrication dencres, industries lectroniques, fontes et activits de soudure sont, entre autres, des situations relles a en tenir compte. La pntration du plomb inorganique dans lorganisme se fait principalement par voie respiratoire, pouvant se faire galement par voie digestive. Les particules absorbes sont transportes par le sang, surtout lies aux rythrocytes (95%), se repartent travers les tissus mous et se dposent essentiellement dans le tissu osseux, o elles reprsentent plus de 90% de la charge corporelle de ce qui a t absorb et ont un temps de demi-vie lev (plus de 20 ans). Le plomb nest pas mtabolis dans lorganisme et son limination se fait essentiellement par voie rnale, pouvant tout de mme, une moindre chelle, tre excrt dans les fces, de la sueur, de la salive, des ongles, des cheveux et du lait maternel. La connaissance scientifique met en vidence que des concentrations sanguines de plomb entre 20 et 50 mg/dL sont susceptibles de dterminer des effets adverses dans lhomme, pouvant les systmes hmatopotique, nerveux, cardiovasculaire, reproducteur et immunitaire en tre affects. Cependant, il en reste beaucoup claircir dans le domaine de la toxicit du plomb. Les niveaux dexposition auxquels correspondent les modifications des divers organes et systmes, demeurent toujours sujet de quelque controverse. Les caractristiques carcinogniques et mutagniques du plomb restent toujours un champ dinvestigation dune grande exigence. Lintoxication par le plomb et ses sels (Saturnisme) dorigine occupationnelle est reconnue, au Portugal, comme une maladie professionnelle (groupe 1- Maladies Provoques par des Agents Chimiques, de la Liste des Maladies Professionnelles). Cest une intoxication du tipe chronique, due labsorption continue de doses relativement petites pendant une longue priode, mise en vidence travers des signes et des symptmes vagues et diffus sans grande spcificit, lesquels peuvent inclure, particulirement, le manque dapptit, got mtallique dans la bouche, pleur, malaise et fatigue, cphales, myalgies et arthralgies, irritabilit, tremblements fins, constipation, coliques abdominales, insomnies, dficit de la mmoire court terme et de la capacit de concentration.Un ensemble important dindicateurs biologiques peut tre employ dans la vigilance priodique de la sant des travailleurs dans ces conditions dexposition. Ces indicateurs (de dose ou deffet) renferment diffrentes significations et comportent diverses exigences, devant le Mdecin de Travail, dans le domaine des programmes de prvention des effets adverses qui sont en relation avec lexposition professionnelle au plomb, slectionner son utilisation et interprter son information de faon valuer linteraction de llment toxique avec lorganisme un stade de rversibilit. Ltude ci-prsent engloba 180 travailleurs desquels 110 prsentaient des plombmies (Pb-S) gales ou suprieures 40 mg/dL. part la Pb-S, la protoporphyrine-zinc (PPZ) leur a t prise en dosage et un Hmogramme fut effectu et fut dtermin lacide d- aminolvulinique urinaire (ALA-U) sur environ 25% des travailleurs. Le dosage de la PPZ efectu en chantillon de sang capillaire par un fluorimtre portable, sest accomplit dune fiabilit total, donnant du sgnificat une tchnique de facile execution et bas prix. Lvaluation de la prise urinaire par dosage du ALA-U conclut au besoin dun recours aux urines de 24 heures Les rsultats de ltude ont mis en vidence une association leve entre la PPZ et la Pb- S, avec une intensit majeure et de dbut plus prcoce par rapport celui qui fut registr lors de lassociation de la Pb-S avec la ALA-U. Ces rsultats ont galement montr de faibles niveaux dassociation entre lhmoglobine (et autres paramtres hmatologiques) et la Pb-S. Ils ont dmontr aussi, une valeur de cut-off de 100 mg/dL de PPZ, des taux de faux ngatifs et faux positifs, pour des plombmies de 70 mg/dL, infrieurs 20%. On peut donc conclure que dans les protocoles de vigilance de la sant des travailleurs exposs au plomb, le dosage de la PPZ par fluorimetrie dans le sang capillaire est adquat, fiable et de ralisation prfrentielle par rapport celui du ALA-U. On peut galement conclure que la ralisation de lhmogramme ne se justifie que dans les cas individuels o, cliniquement, celui-ci est conseill. De plus, ces protocoles doivent inclure la ralisation de la Pb-S et de la PPZ, pouvant, en cas de contrle rigoureux (ambiantal, biologique et clinique), sappuyer que dans la dtermination de la PPZ rservant les autres indicateurs pour approfondir linvestigation mdicale dans les cas o les taux de celle-ci sont levs ou dans les cas de situations limitantes. Summary Any strategy to evaluate and prevent the risks of chemical agents exposure must always regard the work environment and workers health as complementary aspects of one reality - the resulting risks from the interaction between the chemical agent and the exposed workers. It is the responsibility of Environmental Monitoring to evaluate the risks of exposure by the characterization of the chemical agent in the work environment. Biological Monitoring, on the other hand, pronounces itself over the toxin and body interaction, evaluating human response to the chemical aggression and the body adaptations to the toxic absorption. Biological Exposure Indices (BEI) assume, therefore, a privileged status among exposed workers' health monitoring instruments, as they measure the actual penetrated and absorbed toxic quantity and the effect it produces. This research study aims to contribute to the definition of a methodological strategy on the utilization of BEIs in evaluating inorganic lead's occupational exposure, more specifically appreciating the zinc protoporphyrin (ZPP) variation, an index that has never been taken under consideration in Portugal until now. Lead is a natural metal whose ecosystems levels are mainly due to domestic and industrial anthropogenic activities. Its pollutant capacity is notable, representing a permanent exposure risk shown by its constant presence in the human body, although it has no physiologic function. Nowadays, lead's applications are countless, turning its professional exposure a huge reality: storage batteries industries, glass industries, plasterers and munitions industries, building construction, ships and motor car maintenance and repairing, ink manufacture, electronics industries, foundries and other soldering activities are, among so many other, realities to attend to. Respiration is the main cause of human body's inorganic lead absorption, although digestive pathway must not to be ignored. The absorbed particles are transported by blood, essentially bounded to erythrocytes (95%). It is distributed by soft tissues and settled mainly on bone tissues, where it represents approximately 90% of the total body charge and has a high half-life time (more than 20 years). It is not metabolized by the organism, its elimination being effectuated by renal activity and, in smaller scale, through lees, sweat, saliva, nails, hair and maternal milk.Scientific knowledge shows that concentrations of lead in blood between 20 e 50 mg/dL are susceptible to determine adverse effects in man and able to affect the hematopoietic system, the nervous system, the cardiovascular system, the reproductive system and the immunological system. Nevertheless, there's still much to be learned and clarified about lead's toxicity. The correlation between exposure levels and human's systems and organs alteration levels continues to be a centre of controversies. Still, lead's carcinogenic and mutagenic characteristics continue to be a high demanding research field. Intoxication by lead and its compounds (saturnism), from occupational origin, is recognized in Portugal as an occupational disease, included in Group 1 - Chemical Agents Caused Diseases, on the Occupational Diseases List. It is a chronic intoxication caused by a continuous absorption of small doses, throughout a long period of time. Its signs and symptoms are diffuse and imprecise, of great unspecificity, such as loss of appetite, metallic flavor in the mouth, paleness, ailment and fatigue, headaches, myalgia and arthralgia, irritability, thin tremors, constipation, abdominal pain, insomnias, short memory loses and inability to concentrate. A considered number of BEIs can be used in Periodic Health Monitoring of workers in such exposure conditions. Such BEI (dose indices or effect indices) provide different meanings and imply different procedures, being Occupational Doctors responsibility, in the context of lead related adverse effects preventive programmes, to select and interpret its information, in order to evaluate the interaction between toxic and organism in a reversible phase of the toxic action. The present research study involved 180 workers, 110 of which presented blood lead levels (PbB) above or equal to 40 mg/dL. Besides PbB, all workers has been evaluated for zinc protoporphyrin levels (PPZ) and submitted to a haemogram. About 25% of the workers were selected for d-aminolevulinic urinary acid (ALA-U) determination. The evaluation of PPZ, by a portable hematofluorometer using capillary blood samples, turned out to be an easy procedure with low costs and total warrantability. As in regard for ALA- U procedure, it was concluded the necessity of 24 hours urine samples. This research results underlined a strong connection between ZPP and PbB, which was found to to be stringer and to begin earlier than it was registered for PbB and ALA-U association. The same study also revealed a low association level between PbB and hemoglobin or other hematological indices. It was also verified less than 20% of false negatives and false positives cases when admitted a ZPP 100 mg/dL cut off value for PbB 70 mg/dL. As in result it was concluded that in Health Monit
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The prescribed fire is a technique that is often used, it has several advantages. Pedological and hydropedological techniques were tested to assess the prescribed fire changes may cause in soils. This work was performed in Tresminas area (Vila Pouca de Aguiar, Northern Portugal), during February and March 2011. In the present study we applied several techniques. For the field sampling was followed the ISO 10381-1[1], ISO 10381-2[2], and FAO rules [3], as well as were used a grid with 17 points for measuring the soil parameters. During the fire, we have tried to check, with the assistance of the Portuguese Forestry Authority, some important parameters such as, the propagation speed, the size of the flame front and the intensity of energy emitted per unit area. Before the fire, was collected carefully soil disturbed and undisturbed samples for laboratory analysis, and measured soil water content; we also have placed four sets of thermocouples for measuring soil temperature. After the fire, were collected the thermocouples and new soil samples; the water content were measured in the soil and collected ashes. In the laboratory, after preparing and sieving the samples, were determined the soil particle size. The soil pH and electrical conductivity in water was also determined. The total carbon (TC) and inorganic carbon (IC)[4] was measured by a Shimadzu TOC-Vcsn. The water content in soil has not varied significantly before and after the fire, as well as soil pH and soil electrical conductivity. The TC and IC did not change, which was expected, since the fire not overcome the 200 C. Through the various parameters, we determined that the prescribed fire didnt affect the soil. The low temperature of the fire and its rapid implementation that lead to the possible adverse effects caused by the wild fire didnt occurred.
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Background: The role of persistent organic pollutants (POPs) with endocrine disrupting activity in the aetiology of obesity and other metabolic dysfunctions has been recently highlighted. Adipose tissue (AT) is a common site of POPs accumulation where they can induce adverse effects on human health. Objectives: To evaluate the presence of POPs in human visceral (vAT) and subcutaneous (scAT) adipose tissue in a sample of Portuguese obese patients that underwent bariatric surgery, and assess their putative association with metabolic disruption preoperatively, as well as with subsequent body mass index (BMI) reduction. Methods: AT samples (n=189) from obese patients (BMI 35) were collected and the levels of 13 POPs were determined by gas chromatography with electron-capture detection (GC-ECD). Anthropometric and biochemical data were collected at the time of surgery. BMI variation was evaluated after 12 months and adipocyte size was measured in AT samples. Results: Our data confirm that POPs are pervasive in this obese population (96.3% of detection on both tissues), their abundance increasing with age (RS=0.310, p<0.01) and duration of obesity (RS=0.170, p<0.05). We observed a difference in AT depot POPs storage capability, with higher levels of POPs in vAT (213.9204.2 compared to 155.1147.4 ng/g of fat, p<0.001), extremely relevant when evaluating their metabolic impact. Furthermore, there was a positive correlation between POP levels and the presence of metabolic syndrome components, namely dysglycaemia and hypertension, and more importantly with cardiovascular risk (RS=0.277, p<0.01), with relevance for vAT (RS=0.315, p<0.01). Finally, we observed an interesting relation of higher POP levels with lower weight loss in older patients. Conclusion: Our sample of obese subjects allowed us to highlight the importance of POPs stored in AT on the development of metabolic dysfunction in a context of obesity, shifting the focus to their metabolic effects and not only for their recognition as environmental obesogens.
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A vigilncia de efeitos indesejveis aps a vacinao complexa. Existem vrios actores de confundimento que podem dar origem a associaes esprias, meramente temporais mas que podem provocar uma percepo do risco alterada e uma consequente desconfiana generalizada acerca do uso das vacinas. Com efeito as vacinas so medicamentos complexos com caractersticas nicas cuja vigilncia necessita de abordagens metodolgicas desenvolvidas para esse propsito. Do exposto se entende que, desde o desenvolvimento da farmacovigilncia se tem procurado desenvolver novas metodologias que sejam concomitantes aos Sistemas de Notificao Espontnea que j existem. Neste trabalho propusemo-nos a desenvolver e testar um modelo de vigilncia de reaces adversas a vacinas, baseado na auto-declarao pelo utente de eventos ocorridos aps a vacinao e testar a capacidade de gerar sinais aplicando clculos de desproporo a datamining. Para esse efeito foi constituda uma coorte no controlada de utentes vacinados em Centros de Sade que foram seguidos durante quinze dias. A recolha de eventos adversos a vacinas foi efectuada pelos prprios utentes atravs de um dirio de registo. Os dados recolhidos foram objecto de anlise descritiva e anlise de data-mining utilizando os clculos Proportional Reporting Ratio e o Information Component. A metodologia utilizada permitiu gerar um corpo de evidncia suficiente para a gerao de sinais. Tendo sido gerados quatro sinais. No mbito do data-mining a utilizao do Information Component como mtodo de gerao de sinais parece aumentar a eficincia cientfica ao permitir reduzir o nmero de ocorrncias at deteco de sinal. A informao reportada pelos utentes parece vlida como indicador de sinais de reaces adversas no graves, o que permitiu o registo de eventos sem incluir o vis da avaliao da relao causal pelo notificador. Os principais eventos reportados foram eventos adversos locais (62,7%) e febre (31,4%).------------------------------------------ABSTRACT: The monitoring of undesirable effects following vaccination is complex. There are several confounding factors that can lead to merely temporal but spurious associations that can cause a change in the risk perception and a consequent generalized distrust about the safe use of vaccines. Indeed, vaccines are complex drugs with unique characteristics so that its monitoring requires specifically designed methodological approaches. From the above-cited it is understandable that since the development of Pharmacovigilance there has been a drive for the development of new methodologies that are concomitant with Spontaneous Reporting Systems already in place. We proposed to develop and test a new model for vaccine adverse reaction monitoring, based on self-report by users of events following vaccination and to test its capability to generate disproportionality signals applying quantitative methods of signal generation to data-mining. For that effect we set up an uncontrolled cohort of users vaccinated in Healthcare Centers,with a follow-up period of fifteen days. Adverse vaccine events we registered by the users themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. The methodology we used allowed for the generation of a sufficient body of evidence for signal generation. Four signals were generated. Regarding the data-mining, the use of Information Component as a method for generating disproportionality signals seems to increase scientific efficiency by reducing the number of events needed to signal detection. The information reported by users seems valid as an indicator of non serious adverse vaccine reactions, allowing for the registry of events without the bias of the evaluation of the casual relation by the reporter. The main adverse events reported were injection site reactions (62,7%) and fever (31,4%).
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Introduo: Entende-se por fitoterapia a teraputica caracterizada pelo uso de plantas medicinais nas diferentes formas farmacuticas com finalidade teraputica, usada assim para prevenir, atenuar ou curar um estado patolgico. Objetivos: Caracterizar a utilizao de plantas aromticas e medicinais (PAMs), medicamentos e produtos base de plantas pela populao do concelho de Bragana, conhecer a fonte de indicao deste tipo de produtos, apurar a relao entre a fonte de indicao e o estado de sade aps a utilizao, verificar a sua correta utilizao relativa indicao teraputica, modo e frequncia de utilizao, identificar potenciais interaces medicamentosas, averiguar se os utentes informam o mdico do seu uso, investigar a ocorrncia de efeitos adversos e apurar a relao entre os efeitos adversos ocorridos e o gnero dos inquiridos. Mtodos: Trata-se de um estudo observacional analtico-transversal. Nele participaram 404 indivduos de ambos os gneros e com idades compreendidas entre os 18 e os 89 anos. A recolha de dados foi realizada entre os meses de abril e junho de 2014, atravs de um questionrio estruturado de autopreenchimento, formado por 30 perguntas. Aps a recolha dos dados procedeu-se leitura ptica dos questionrios, sendo os dados posteriormente exportados para SPSS permitindo assim o tratamento dos mesmos. Para anlise estatstica utilizou-se o teste do qui-quadrado considerando o nvel de significncia p <0,05. Resultados: Verificou-se que 53,7% dos inquiridos recorre terapeuticamente a PAMs que inclui principalmente o uso de cidreira e camomila enquanto 33,8% faz uso de medicamentos e/ou produtos base de plantas nomeadamente Valdispert e Daflon. A utilizao de PAM,s motivada por autoconhecimento e indicao de familiares, amigos e vizinhos. J os medicamentos e/ou produtos base de plantas so utilizados maioritariamente por prescrio mdica e indicao na farmcia. A ocorrncia de efeitos indesejveis foi sentida unicamente com a utilizao de PAMs e em pequena escala. Concluso: O recurso a este tipo de produtos uma prtica bastante comum entre os moradores do concelho de Bragana, que utilizam uma grande diversidade de plantas e produtos base de plantas para um variado leque de indicaes teraputicas, apontando a percentagem de respostas para um conhecimento dos seus efeitos teraputicos.
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Dissertao apresentada para a obteno do grau de doutor em Bioqumica pela Universidade Nova de Lisboa, Faculdade de Cincias e Tecnologia
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Tendo por referncia a diretiva 2006/95/CE, o trabalho desenvolvido no contexto da disciplina de Dissertao/Projeto/Estgio do Mestrado de Engenharia de Instrumentao e Metrologia, decorreu nas instalaes do IEP (Instituto Electrotcnico Portugus) e teve como objetivo principal o desenvolvimento de um procedimento de avaliao dos efeitos fotobiolgicos no olho e pele provocados por fontes de emisso contnua (LED), doravante designado mtodo alternativo ao de referncia. Os dois mtodos, alternativo e de referncia, utilizam respectivamente um foto-radimetro multicanal e um espetro-radimetro. O procedimento desenvolvido (mtodo alternativo) de acordo com a norma EN/IEC62471) consiste na aquisio dos valores de irradincia com recurso a um foto-radimetro e posterior determinao dos valores da radincia, com os quais se faz a avaliao dos efeitos fotobiolgicos, para fontes de luz LED (Light Emitting Diode) ou GLS (General Lighting Service). A consulta detalhada da norma EN/IEC62471 e a pesquisa sobre os conceitos, definies, equipamentos e metodologias relacionadas com o tema em causa, constituiu o primeiro passo deste projecto. Com recurso aos dois equipamentos, uma fonte de luz LED (mdulo de 12 lmpadas LED) avaliada em relao aos perigos (ou riscos) actnico UV e UV-A, ao perigo da luz azul e ainda o perigo trmico na retina e trmico na pele, permitindo fazer uma anlise comparativa dos resultados. O mtodo alternativo revelou-se bastante flexvel e eficaz, proporcionando bons resultados em termos da irradincia e radincia dos referidos efeitos fotobiolgicos. A comparao destes resultados com os valores limites de exposio mencionados na norma EN/IEC6247 permitiu afirmar que a fonte de luz LED avaliada no representa perigo fotobiolgico para a sade humana e classifica-se no grupo de risco isento. Uma vez cumpridos os objectivos, entendeu-se que seria uma mais-valia para o trabalho j realizado, estudar outro caso prtico. Sendo assim, fez-se a avaliao da radiao de apenas um dos LEDs que constituam a fonte usada nos ensaios anteriores, com o espetro-radimetro (mtodo de referncia) e com uma distncia de 200 mm entre a fonte e o medidor. Neste caso verificaram-se diferenas significativas nas quantidades obtidas quando comparadas com os valores normativos. Concluiu-se que o efeito fotobiolgico da luz azul insere-se no grupo de isento, sem perigo para a sade. Contudo, o efeito trmico da retina apresenta um aumento considervel da quantidade de radincia, embora dentro do grupo de risco isento. Esta classificao de grupos de risco. Face aos resultados obtidos, pode confirmar-se que as lmpadas LED apresentam segurana fotobiolgica, atendendo aos baixos valores de irradincia e radincia dos efeitos fotobiolgicos estudados. Pode ainda afirmar-se que a utilizao do foto-radimetro em alternativa ao espetro-radimetro se revela mais eficaz do ponto de vista de metodologia prtica. Este trabalho demonstra a robustez desses dois equipamentos de avaliao dos efeitos fotobiolgicos, e procura estabelecer uma linha de orientao para a preveno dos efeitos adversos na pele e olhos de todos os seres humanos sujeitos radiao tica artificial. Quanto s incertezas de medies, em relao ao processo de medio com foto-radimetro, a sua estimao no se realizou, devido a no rastreabilidade entre as medies indicadas pelo fabricante, no certificado de calibrao e as medidas realizadas por outras entidades. Contudo, prope-se a sua realizao em trabalhos futuros dentro desse mbito. As incertezas dos resultados de medies com espetro-radimetro foram parcialmente estimadas. Atendendo s potencialidades do sistema de medio, prope-se como trabalho futuro, a aplicao da norma IEC62478, que faz parte da aplicao da norma EN/IEC62471 na avaliao do efeito da luz azul, com base na determinao da temperatura de cor correlacionada (CCT) de lmpadas ou sistemas de lmpadas incluindo luminrias. Os valores de irradincia e radincia adquiridos nos processos de avaliao, tanto com foto-radimetro como espectro-radimetro foram gravados em ficheiro Excel para um CD e anexados a este trabalho.
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This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (04 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.
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Thesis submitted to the Universidade Nova de Lisboa, Faculdade de Cincias e Tecnologia for the degree of Doctor of Philosophy in Environmental Sciences
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Dissertao apresentada Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Doutor em Engenharia Civil
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The production of bioactive compounds either toxic or with pharmacological applications by cyanobacteria is well established. However, picoplanktonic forms within this group of organisms have rarely been studied in this context. In this study, the toxicological potential of picocyanobacteria from a clade of marine Cyanobium strains isolated from the Portuguese coast was examined using different biological models. First, strains were identified by applying morphological and molecular approaches and cultured under lab conditions. A crude extract and three fractions reflecting a preliminary segregation of lipophilic metabolites were tested for toxicity with the marine microalga Nannochloropsis sp., the bacteria Pseudomonas sp., the brine shrimp Artemia salina, and fertilized eggs of the sea urchin Paracentrotus lividus. No significant apparent adverse effects were noted against Artemia salina. However, significant adverse effects were found in all other assays, with an inhibition of Nannochloropsis sp. and Pseudomonas sp. growth and marked reduction in Paracentrotus lividus larvae length. The results obtained indicated that Cyanobium genus may serve as a potential source of interesting bioactive compounds and emphasize the importance of also studying smaller picoplanktonic fractions of marine cyanobacteria.
