Browsing by Author "Aguiar, P."
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- Analysis and Identification of Trihalomethanes in Lisbon Indoor Swimming Pools: Distribution, Determinants and Human ExposurePublication . Silva, Z.; Rebelo, H.; Silva, M.M.; Alves, A.; Cabral, C.; Almeida, A.C.; Aguiar, F.; Oliveira, A.; Nogueira, A.; Pinhal, H.; Matos, A.; Ramos, C.D.; Pacheco, P.; Aguiar, P.; Cardoso, A.S.Water disinfection methods are used in swimming pools to ensure an effective protection of users against microbiological pathogens, being chlorination the most common disinfection method used worldwide. The use of chlorine based treatment techniques has one strong drawback, which is the generation of disinfection by-products (DBPs), potentially harmful products that have been associated with respiratory and ocular symptoms, bladder cancer and adverse reproductive effects. Amongst DBPs, the most better characterized are trihalomethanes (THMs): chloroform (CF), bromoform (BF), bromodichloromethane (BDCM), and chlorodibromomethane (DBCM). In Portugal a specific legislation to assess the quality of swimming pools is inexistent. The guideline value used to evaluate total THMs in water (TTHMsW) is the one established in the Law 306/2007 - 100 μg/L. Some other water/air parameters were assessed by Law 5/97, WHO guidelines for safe recreational water environments (2006) and Standard 62.1 (2006) from American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASRHAE). The main goal of this investigation was to study the occurrence, distribution and determinants of THMs in indoor swimming pools. This will also enable an evaluation of the exposure of users to THMs. In order to achieve this goals, the characterization of water quality in 30 Lisbon indoor swimming pools, using chorine based treatment techniques, was made during a six month period. Several parameters such as TTHMs, CF, BDCM, DBCM, BF levels in water, free residual chlorine (FrCl), pH, TW, Tair, Hu, chemical oxygen demand (COD), and other, were determined in each pool, once a month. Statistical analysis was performed using the SPSS 17.0 software. Descriptive analysis was applied to all variables. Student’s t-test, Mann-Whitney tests and Spearman’s rank correlation coefficient were also used. Large variation in TTHMs and CF water levels between the pools was obtained, being CF the THM obtained in higher concentrations, with sporadic higher values than the allowed. In air, CF level (CFair) also presented occasional higher levels. There was a clear positive linear correlation between CFW and TTHMsW (R>0.95, p<0.01), CFW and CFair (R> 0.5; p<0.05), CFW and FrCl (R>0.2; p<0.05) and, CFw and Tw (R>0.2; p<0.05). Good correlations were also obtained between other THMs: BDCM and DBCM (R>0.5, p<0.01) and BF and DBCM (R>0.6; p<0.05). The strong positive correlation obtained between CFW and TTHMsW was expected, since, usually, CFW has the higher contribution to TTHMsW. CFW is often considered as a good indicator of TTHMs concentration in water. Therefore correlations between TTHMs and CFair, FrCl, and Tw were expected and observed: TTHMsW vs CFair (R>0.5; p<0.05), TTHMsW vs FrCl (R>0.2; p<0.05) and TTHMsW vs TW (R>0.2; p<0.01). In conclusion, reasonable water and air quality was obtained in the studied Lisbon swimming pools, although some pools presented high TTHMsW, CFW and CFair. These results clearly demonstrate that THMs monitoring is particularly important and that, in a near future, this should be extended to other DBPs. Furthermore, for conscious use of swimming pools, appropriate and targeted information about safe practices should be provided to pool users.
- ApoB/ApoA1 ratio improves clinical criteria sensitivity for the identification of FH childrenPublication . Medeiros, A.M.; Alves, A.C.; Aguiar, P.; Bourbon, M.
- Cardiovascular risk assessment of dyslipidemic children: analysis of biomarkers for the correct assessment of monogenic dyslipidemiaPublication . Medeiros, A.M.; Alves, A.C.; Aguiar, P.; Bourbon, M.; Estudo Português de Hipercolesterolemia Familiar
- Looks Like FH But it’s not FH: Extended Lipid Profile of Paediatric Clinical FH Patients Reveals a Different Lipid Profile in FH Negative PatientsPublication . Medeiros, A.M.; Aguiar, P.; Bourbon, MafaldaAim: Familial Hypercholesterolemia (FH) is a common autosomal dominant disorder, caused by mutations in genes involved in cholesterol’s clearance (LDLR, APOB, PCSK 9). Clinical diagnosis is usually based on high total cholesterol or LDL-C levels and family history of premature coronary heart disease. Using an extended lipid profile of paediatric dyslipidemic patients, we aim to identify biomarkers for a better diagnosis of FH in clinical settings.
- Mutational analysis and genotype-phenotype relation in familial hypercholesterolemia: The SAFEHEART registryPublication . Bourbon, M.; Alves, A.C.; Alonso, R.; Mata, N.; Aguiar, P.; Padró, T.; Mata, P.Background and aims: Familial hypercholesterolemia (FH) is an autosomal dominant disease of cholesterol metabolism that confers an increased risk of premature atherosclerotic cardiovascular disease (ASCVD). Therefore, early identification and treatment of these patients can improve prognosis and reduce the burden of cardiovascular mortality. The aim of this work was to perform the mutational analysis of the SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) registry. Methods: The study recruited 2938 individuals with genetic diagnosis of FH belonging to 775 families. Statistical analysis was performed using SPSS v23. Results: A total of 194 variants have been detected in this study, 24 of them were never described before. About 88% of the patients have a pathogenic or likely pathogenic variant. Patients with null variants have a more severe phenotype than patients with defective variants, presenting with significantly higher levels of atherogenic particles (total cholesterol, LDL-cholesterol and apolipoprotein B). Conclusions: This study shows the molecular characteristics of the FH patients included in the SAFEHEART registry and the relationship with the phenotypic expression. The majority of the genetic variants are considered to be pathogenic or likely pathogenic, which confers a high level of confidence to the entry and follow-up data analysis performed with this registry concerning FH patients' prognosis, treatment and survival.
- Patterns of adherence to and compliance with the Portuguese smoke-free law in the leisure-hospitality sectorPublication . Reis, M.F.; Namorado, Sónia; Aguiar, P.; Precioso, J.; Nunes, Baltazar; Veloso, L.; Santos, S.; Miguel, J.P.Background: In 2008, the Portuguese smoke-free law came into effect including partial bans in the leisure-hospitality (LH) sector. The objective of the study is to assess the prevalence of smoking control policies (total ban, smoking permission and designated smoking areas) adopted by the LH sector in Portugal. The levels of noncompliance with each policy are investigated as well as the main factors associated with smoking permission and noncompliance with the law. Methods: Cross-sectional study conducted between January 2010 and May 2011. A random sample of venues was selected from the Portuguese LH sector database, proportionally stratified according to type, size and geographical area. All venues were assessed in loco by an observer. The independent effects of venues' characteristics on smoking permission and the level of noncompliance with the law were explored using logistic regression. Results: Overall, 1.412 venues were included. Total ban policy was adopted by 75.9% of venues, while 8.4% had designated smoking areas. Smoking ban was more prevalent in restaurants (85.9%). Only 29.7% of discos/bars/pubs opted for complete ban. Full or partial smoking permission was higher in discos/bar/pubs (OR = 7.37; 95%CI 4.87 to 11.17). Noncompliance with the law was higher in venues allowing smoking and lower in places with complete ban (33.6% and 7.6% respectively, p<0.001). Discos/bars/pubs with full smoking permission had the highest level of noncompliance (OR = 3.31; 95%CI 1.40 to 7.83). Conclusions: Our findings show a high adherence to smoking ban policy by the Portuguese LH sector. Nonetheless, one quarter of the venues is fully or partially permissive towards smoking, with the discos/bars/pubs considerably contributing to this situation. Venues with smoking permission policies were less compliant with the legislation. The implementation of a comprehensive smoke-free law, without any exceptions, is essential to effectively protect people from the second hand smoke.
- Smoking behaviour trends among Portuguese physicians: are they role models? A conference-based surveyPublication . Ravara, S.B.; Castelo-Branco, M.; Aguiar, P.; Calheiros, José M.
- Trihalomethanes in Lisbon Indoor Swimming Pools: Occurrence and Determining FactorsPublication . Silva, Z.; Rebelo, H.; Silva, M.M.; Alves, A.; Cabral, C.; Almeida, A.C.; Aguiar, F.; Oliveira, A.; Nogueira, A.; Pinhal, H.; Matos, A.; Ramos, C.D.; Pacheco, P.; Aguiar, P.; Cardoso, A.S.The presence of water disinfection by-products (DBPs) in swimming pools constitutes today a public health concern, particularly because swimming is an activity used by a high percentage of the population, namely elderly and young children. Moreover, several adverse short-term and long-term health effects have been associated with these compounds (Lakind et al., 2010; Zwiener et al., 2007). Water disinfection methods are used in all swimming pools, namely in public pools, to ensure an adequate and effective protection of users against microbiological pathogens. Chlorination is the most common disinfection method used worldwide, because it is low cost, easy to use, efficient against a broad spectrum of microorganisms, and enables the maintenance of a residual protection. The use of chlorine based treatment techniques has one strong drawback, which is the generation of several DBPs, potentially harmful products, that can be absorbed by ingestion, inhalation and absorption through the skin (Nieuwenhuijsen et al., 2009; Caro and Gallego, 2007). DBPs comprise several compounds that are formed through the reaction of chlorine with organic matter present in water. Amongst DBPs, the most relevant and better characterized are trihalomethanes (THMs): chloroform (CF), bromoform (BF), bromodichloromethane (BDCM), and chlorodibromomethane (DBCM). These compounds have been associated with health effects such as respiratory, ocular and cutaneous symptoms and also with some long-term health effects such as bladder cancer and adverse reproductive outcomes (Lee et al., 2009; Zwiener et al., 2007). Accurate exposure assessments to THMs in indoor pool environment is particularly difficult because their formation depends on many factors such as water and air temperature (Tw and Tair), humidity (Hu), pH, free residual chlorine (FrCl), total organic content and number of pool users (Lee et al., 2009). In Portugal a specific legislation to assess the quality of swimming pool waters is inexistent. The guideline value used in this study for total THMs (TTHMs) was the one established in the Portuguese Law 306/2007, for drinking water quality - 100 μg/L. Some other water parameters determined in swimming pools such as Tw turbidity (Turb), pH, FrCl, total residual chlorine, conductivity (Cond), permanganate index (COD) and isocyanuric acid were assessed by Portuguese Law 5/97, regarding technical and safety conditions of closed environments with water diversions. WHO guidelines for safe recreational water environments (2006) were also used to assess some water and air parameters in pools. Standard 62.1 (2006) from American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASRHAE) was also used to assess pool air parameters. The main goal of this investigation project was to study the occurrence, distribution and determinants of THMs in indoor swimming pools. This will enable an evaluation of swimming pool users’ exposure to THMs. In order to achieve this goal, the characterization of water quality of 30 Lisbon indoor swimming pools, using chorine based treatment techniques, was made during a six month period. Because of laboratory working restrictions, CF concentration in pool air was studied only in 6 swimming pools, at the same period. Several parameters such as TTHMs concentration, CF, BDCM, DBCM, BF concentration in water, FrCl, combined residual chlorine (CrCl), pH, Tw and Tair, Hu, COD, Cond, Turb and chloride (Cl) were determined in each pool, once a month. THMs water sampling was made in duplicates in two pool water spots, physicochemical parameters were determined in one of the THMs water sampling spots and THMs air sampling was made in two pool spots, considered to be representative of the swimming pool air. All sampling procedures were performed by specialized sampling technicians from Lisbon Health Centres Group (ACES). Statistical analysis was performed using the SPSS 17.0 software. Descriptive analysis was applied to all variables in order to determine mean, median, standard deviation, minimum and maximum. Student’s t-test and Mann-Whitney tests were used to compare numerical variables and Spearman’s rank correlation coefficient were used to examine correlation between all environmental parameters. TTHMs water level ranged from 10 to 160 μg/L, while CF water level typically ranged from 5 to 150 μg/L, with occasional higher levels detected. Regarding other THMs levels in pool water, BDCM ranged from 0.5 to 15 μg/L, DBCM from 0.4 to 10 μg/L and BF was obtained in concentrations less than 2 μg/L. Moreover, in some pools, DBCM and BF were not detected. From these results, it can be concluded that there was a large variation in TTHMs and CF water levels between the pools and that CF was the THM obtained in higher concentrations. These results are in agreement with studies presented by other authors (Lee et al., 2009; Chu and Nieuwenhuijsen, 2002). In air, CF level ranged from 40 to 200 μg/m3, with occasional higher levels detected. Tw presented less variation (27 to 31 ºC) than Tair (21 to 33 ºC), although sporadic higher values were found. FrCl and Cond presented higher values than the guidelines from DR 5/97 only in a small number of pools. Turb and COD values were within the guidelines from DR 5/97. pH varied from 7 to 8.5, with only a small number of pools having values higher than 7.8. As referred in WHO guidelines, pH should be maintained between 7.2 and 7.8 for chlorine disinfectants to ensure efficient disinfection. Using the statistical tests mentioned before, it was possible to obtain some interesting results. There was a clear positive linear correlation between CF water concentration (CFW) and TTHMs water concentration (R>0.98, p<0.01), good correlation other THMs, there was a clear positive linear correlation between BDCM and DBCM water concentration (R>0.78, p<0.01) and good correlation between TTHMs water concentration and Tw (R>0.45, p<0.05). These results are in agreement with Lee et al. (2009) which obtained positive linear correlations between CFW and COD and with Chu and Nieuwenhuijsen (2002) which also obtained correlations between TTHMs water concentration and Tw. In conclusion, there appears to be good water and air quality in the studied Lisbon swimming pools. Regarding THMs levels in water, some pools presented high TTHMs and CF concentrations. Moreover, CF air concentrations were also high in some swimming pools. These results clearly demonstrate that THMs monitoring is particularly important and that, in a near future, this should be extended to other DBPs. Furthermore, for a correct and conscious use of swimming pools, appropriate and targeted information about safe practices should be provided to pool users.