Browsing by Author "Madureira, Joana"
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- Age-related dose deposition of particulate matter in human respiratory tract: findings from a birth cross-sectional study in PortugalPublication . Madureira, Joana; Slezakova, Klara; Costa, Carla; Silva, Ana Inês; Mendes, Ana; Pereira, Maria do Carmo; Teixeira, João PauloIndoor air pollution remains a great global concern. Particulate matter (PM), namely ultrafine particles (aerodynamic diameter smaller than 0.1 μm; UFP), is considered as one of the most health-relevant air pollutant for various subpopulations, one of which is children. Knowledge on the specific dose deposition of PM may provide a critical link for better understanding of the relationship between individual exposure and the respective health effects. Mathematical models have proven to be important tools for analysing PM dose deposition in the respiratory tract providing relevant data for health risk assessment, source apportionment of human lung burdens and control strategies purposes. This work aimed to estimate the deposition dose of different PM sizes at different age categories. Inhalation dosimetry estimations were carried out using the multiple-path particle dosimetry model (MPPD, v3.04). Age specific 5-lobe model with uniform expansion was adopted in the present study
- Air pollution in urban environments: implications for citizens´healthPublication . Slezakova, Klara; Madureira, Joana; Teixeira, João Paulo; Pereira, Maria do CarmoCurrently, 54% of worldwide population lives in urban areas. While growing urbanization causes environmental pollution and energy demand, it has also adverse implications on health, living conditions and lifestyle habits of the respective citizens. To protect human health, numerous organizations have implemented guidelines to limit environmental pollution, or even proposed recommendation on human activity, but how do these translate to the exposure and risks of the respective population? This work aimed to explore how urban development, using time series data from 2015 to 2018, might influence air quality and potential health risks of citizens living in these zones.
- Air pollution: a public health approach for PortugalPublication . Torres, Pedro; Ferreira, Joana; Monteiro, Alexandra; Costa, Solange; Pereira, Maria Carmo; Madureira, Joana; Mendes, Ana; Teixeira, João PauloAt the global level, several epidemiological studies have conclusively pointed out the associations between short-term exposure to air pollution and acute health effects, and long-term exposure with adverse health effects such as premature mortality from severe respiratory and cardiovascular diseases. This study intended to characterize exposures and their adverse health effects. Three independent sets of vectors were analyzed on a nationwide level and annual basis: air pollutant emissions, ambient air concentrations and health indicators of the period 2009 to 2015. The emissions analysis, for the studied pollutants, pointed out the main findings: (i) Lisbon Metropolitan Area presents the most problematic region with regard to the emissions of all the pollutants under study; (ii) the regions of the Alentejo and Algarve showed reduced emissions of the studied pollutants compared to other parts of the country; (iii) Northern regions PM10 concentrations decreased during the two years in analysis. Regarding the analysis of air quality, it was concluded that: (i) regarding ozone, concentration shown a decreasing trend throughout the country; (ii) nitrogen dioxide and particulate matter, concentrations demonstrated an increasing trend in most of the northern part of the country; (iii) the regions of Alentejo and Lisbon Metropolitan Area showed increasing trends for sulfur dioxide and fine particles for the evaluated period. Decreasing trends in mortality associated with cardiovascular and respiratory causes are found mainly in the Alentejo and Algarve regions. In comparison, the North, Central regions, as well as, Lisbon Metropolitan Area exhibited higher mortality values related to this health indicators.
- All-cause, cardiovascular, and respiratory mortality and wildfire-related ozone: a multicountry two-stage time series analysisPublication . Chen, Gongbo; Guo, Yuming; Yue, Xu; Xu, Rongbin; Yu,Wenhua; Ye, Tingting; Tong, Shilu; Gasparrini, Antonio; Bell,Michelle L.; Armstrong, Ben; Schwartz, Joel; Jaakkola, Jouni J.K.; Lavigne, Eric; Saldiva, Paulo Hilario Nascimento; Kan, Haidong; Royé, Dominic; Urban, Aleš; Vicedo-Cabrera, Ana Maria; Tobias, Aurelio; Forsberg, Bertil; Sera, Francesco; Lei, Yadong; Abramson, Michael J.; Li, Shanshan; Abrutzky, Rosana; Alahmad, Barrak; Ameling, Caroline; Åström, Christofer; Breitner, Susanne; Carrasco-Escobar, Gabriel; Coêlho, Micheline de Sousa Zanotti Stagliorio; Colistro, Valentina; Correa, Patricia Matus; Dang, Tran Ngoc; de'Donato, Francesca; Dung, Do Van; Entezari, Alireza; Garcia, Samuel David Osorio; Garland, Rebecca M.; Goodman, Patrick; Guo, Yue Leon; Hashizume, Masahiro; Holobaca, Iulian-Horia; Honda, Yasushi; Houthuijs, Danny; Hurtado-Díaz, Magali; Íñiguez, Carmen; Katsouyanni, Klea; Kim, Ho; Kyselý, Jan; Lee, Whanhee; Maasikmets, Marek; Madureira, Joana; Mayvaneh, Fatemeh; Nunes, Baltazar; Orru, Hans; Ortega, Nicol´s Valdés; Overcenco, Ala; Pan, Shih-Chun; Pascal, Mathilde; Ragettli, Martina S.; Rao, Shilpa; Ryti, Niilo R.I.; Samoli, Evangelia; Schneider, Alexandra; Scovronick, Noah; Seposo, Xerxes; Stafoggia, Massimo; Valencia, César De la Cruz; Zanobetti, Antonella; Zeka, Ariana; behalf of the Multi-Country Multi-City Collaborative Research NetworkBackground: Wildfire activity is an important source of tropospheric ozone (O3) pollution. However, no study to date has systematically examined the associations of wildfire-related O3 exposure with mortality globally. Methods: We did a multicountry two-stage time series analysis. From the Multi-City Multi-Country (MCC) Collaborative Research Network, data on daily all-cause, cardiovascular, and respiratory deaths were obtained from 749 locations in 43 countries or areas, representing overlapping periods from Jan 1, 2000, to Dec 31, 2016. We estimated the daily concentration of wildfire-related O3 in study locations using a chemical transport model, and then calibrated and downscaled O3 estimates to a resolution of 0·25° × 0·25° (approximately 28 km2 at the equator). Using a random-effects meta-analysis, we examined the associations of short-term wildfire-related O3 exposure (lag period of 0-2 days) with daily mortality, first at the location level and then pooled at the country, regional, and global levels. Annual excess mortality fraction in each location attributable to wildfire-related O3 was calculated with pooled effect estimates and used to obtain excess mortality fractions at country, regional, and global levels. Findings: Between 2000 and 2016, the highest maximum daily wildfire-related O3 concentrations (≥30 μg/m3) were observed in locations in South America, central America, and southeastern Asia, and the country of South Africa. Across all locations, an increase of 1 μg/m3 in the mean daily concentration of wildfire-related O3 during lag 0-2 days was associated with increases of 0·55% (95% CI 0·29 to 0·80) in daily all-cause mortality, 0·44% (-0·10 to 0·99) in daily cardiovascular mortality, and 0·82% (0·18 to 1·47) in daily respiratory mortality. The associations of daily mortality rates with wildfire-related O3 exposure showed substantial geographical heterogeneity at the country and regional levels. Across all locations, estimated annual excess mortality fractions of 0·58% (95% CI 0·31 to 0·85; 31 606 deaths [95% CI 17 038 to 46 027]) for all-cause mortality, 0·41% (-0·10 to 0·91; 5249 [-1244 to 11 620]) for cardiovascular mortality, and 0·86% (0·18 to 1·51; 4657 [999 to 8206]) for respiratory mortality were attributable to short-term exposure to wildfire-related O3. Interpretation: In this study, we observed an increase in all-cause and respiratory mortality associated with short-term wildfire-related O3 exposure. Effective risk and smoke management strategies should be implemented to protect the public from the impacts of wildfires.
- Ambient carbon monoxide and daily mortality: a global time-series study in 337 citiesPublication . Chen, Kai; Breitner, Susanne; Wolf, Kathrin; Stafoggia, Massimo; Sera, Francesco; Vicedo-Cabrera, Ana M.; Guo, Yuming; Tong, Shilu; Lavigne, Eric; Matus, Patricia; Valdés, Nicolás; Kan, Haidong; Jaakkola, Jouni J.K.; Ryti, Niilo R.I.; Huber, Veronika; Scortichini, Matteo; Hashizume, Masahiro; Honda, Yasushi; Nunes, Baltazar; Madureira, Joana; Holobâcă, Iulian Horia; Fratianni, Simona; Kim, Ho; Lee, Whanhee; Tobias, Aurelio; Íñiguez, Carmen; Forsberg, Bertil; Åström, Christofer; Ragettli, Martina S-; Guo, Yue-Liang Leon; Chen, Bing-Yu; Li, Shanshan; Milojevic, Ai; Zanobetti, Antonella; Schwartz, Joel; Bell, Michelle L-; Gasparrini, Antonio; Schneider, AlexandraBackground: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting. Methods: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected. Findings: Overall, a 1 mg/m3 increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m3, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m3 or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide. Interpretation: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants.
- Assessment of indoor air exposure among newborns and their mothers: Levels and sources of PM10, PM2.5 and ultrafine particles at 65 home environmentsPublication . Madureira, Joana; Slezakova, Klara; Costa, Carla; Pereira, Maria Carmo; Teixeira, João PauloSignificant efforts have been directed towards addressing the adverse health effects of atmospheric particles, emphasizing the relevance of indoor exposure. Homes represent an indoor environment where human spend the majority of their time. Thus, the objective of this work was to concurrently assess different matrix of indoor particles considering both mass (PM10, PM2.5) and number (N20-1000) concentrations in indoor and outdoor air of homes (n = 65). Real-time measurements (PM10, PM2.5, UFP) were conducted simultaneously during 48 h in dwellings situated in Oporto, Portugal. In 75% of homes, indoor PM2.5 (mean = 53 μg m-3) exceeded limit of 25 μg m-3, for PM10 (mean = 57 μg m-3) 41% of homes demonstrated average levels higher than 50 μg m-3, thus indicating potential risks. Indoor PM10 was mostly (82-99%) composed of PM2.5, both PM were highly correlated (|rs|>0.9655), thus suggesting the similar origin. Indoor PM originated from infiltrations of outdoor emissions; ∼70% of homes exhibited indoor to outdoor (I/O) ratio < 1. On the contrary, UFP indoors (mean = 13.3 × 103 # cm-3) were higher than outdoors (mean = 10.0 × 103 # cm-3). Indoor UFP spatially varied as follows: kitchens > living rooms > bedrooms. UFP indoors were poorly correlated (|rs| = 0.456) with outdoor concentrations, I/O ratios showed that indoor UFP predominantly originated from indoor emission sources (combustions). Therefore, in order to reduce exposure to UFP and protect public health, the primary concerns should be focused on controlling emissions from indoor sources.
- Assessment of indoor air exposure at residential homes: Inhalation dose and lung deposition of PM10, PM2.5 and ultrafine particles among newborn children and their mothersPublication . Madureira, Joana; Slezakova, Klara; Silva, Ana Inês; Lage, Bruna; Mendes, Ana; Aguiar, Lívia; Pereira, Maria Carmo; Teixeira, João Paulo; Costa, CarlaAccurate assessment of particulate matter (PM) dose and respiratory deposition is essential to better understand the risks of exposure to PM and, consequently, to develop the respective risk-control strategies. In homes, this is especially relevant in regards to ultrafine particles (UFP; <0.1 μm) which origin in these environments is mostly due to indoor sources. Thus, this study aimed to estimate inhalation doses for different PM mass/number size fractions (i.e., PM10, PM2.5 and UFP) in indoor air of residential homes and to quantify the deposition (total, regional and lobar) in human respiratory tract for both newborn children and mothers. Indoor real-time measurements of PM10, PM2.5 and UFP were conducted in 65 residential homes situated in Oporto metropolitan area (Portugal). Inhalation doses were estimated based on the physical characteristics of individual subjects and their activity patterns. The multi-path particle dosimetry model was used to quantify age-specific depositions in human respiratory tract. The results showed that 3-month old infants exhibited 4-fold higher inhalation doses than their mothers. PM10 were primarily deposited in the head region (87%), while PM2.5 and UFP depositions mainly occurred in the pulmonary area (39% and 43%, respectively). Subject age affected the pulmonary region and the total lung deposition; higher deposition being observed among the newborns. Similarly, lower lobes (left lobe: 37% and right lobe: 30%) received higher PM deposition than upper and middle lobes; right lobes lung are prone to be more susceptible to respiratory problems, since asymmetric deposition was observed. Considering that PM-related diseases occur at specific sites of respiratory system, quantification of site-specific particle deposition should be predicted in order to better evidence the respective health outcomes resulting from inhaled PM.
- Assessment of Potential Health Risks of Portuguese Wildland Firefighters’ Occupational Exposure: Biomonitoring ApproachPublication . Esteves, Filipa; Madureira, Joana; Teixeira, João Paulo; Costa, SolangeIntroduction: Worldwide, forest fires are among the most common forms of natural disasters. In the closing years of the last century, there was an increase in the burned area in some parts of the globe, including Europe. Portugal has been particularly affected by large forest fires and mega fires, which have been occurred mainly in the central and northern regions. The proximity of firefighters to fire exposes them to high levels of toxic compounds making this occupation one of the most dangerous and leading International Agency for Research on Cancer to classified occupational firefighting activity as possibly carcinogenic to humans. Up to date, the existing studies are mainly focused on environmental monitoring, existing limited information regarding biomonitoring assessments during real scenarios of wildland fires combat. This study aims to evaluate the impact of firefighting occupational exposure at molecular and cellular levels, considering personal exposure levels. Early-effect biomarkers (e.g., micronucleus, DNA strand breaks and oxidative DNA damage) will be analyzed in order to understand the mechanisms of action through which woodsmoke may impact firefighters' health, including the risk of cancer. Methodology: This ongoing prospective longitudinal study will comprise three different stages, specifically pre-exposure, exposure, and post-exposure to fire season. Around 200 wildland northern Portuguese firefighters will be involved in this study. Characterization of the study population will be conducted via questionnaires. Firefighters' personal exposure levels will be assessed by means of metabolites in exhaled breath, using an artificial olfactory system (e-nose technology). Buccal and urine samples will be used to measure genomic instability through a micronucleus test in buccal epithelial cells and urothelial cells. DNA damage and oxidative DNA damage will be evaluated in peripheral blood lymphocytes using the comet assay. Statistical analysis will be performed to determine the relationship between personal exposure levels to toxic compounds and the early-effect biomarkers over the three different phases of the study. Expected results: The obtained results will support a more accurate and comprehensive assessment of occupational risks among wildland firefighters, crucial to prevent/reduce the associated health impacts. This work will contribute to the establishment of recommendations/good practices to improve firefighters' working conditions, allowing better definitions of policies and prevention strategies highly needed in this sector.
- Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 CountriesPublication . Alahmad, Barrak; Khraishah, Haitham; Royé, Dominic; Vicedo-Cabrera, Ana Maria; Guo, Yuming; Papatheodorou, Stefania I.; Achilleos, Souzana; Acquaotta, Fiorella; Armstrong, Ben; Bell, Michelle L.; Pan, Shih-Chun; Coelho, Micheline de Sousa Zanotti Stagliorio; Colistro, Valentina; Dang, Tran Ngoc; Dung, Do-Van; De' Donato, Francesca K.; Entezari, Alireza; Guo, Yue-Liang Leon; Hashizume, Masahiro; Honda, Yasushi; Indermitte, Ene; Íñiguez, Carmen; Jaakkola, Jouni J.K.; Kim, Ho; Lavigne, Eric; Lee, Whanhee; Li, Shanshan; Madureira, Joana; Mayvaneh, Fatemeh; Orru, Hans; Overcenco, Ala Vladimir; Ragettli, Martina S.; Ryti, Niilo R.I.; Saldiva, Paulo Hilario Nascimento; Scovronick, Noah; Seposo, Xerxes; Sera, Francesco; Silva, Susana; Stafoggia, Massimo; Tobias, Aurelio; Garshick, Eric; Bernstein, Aaron S.; Zanobetti, Antonella; Schwartz, Joel D.; Gasparrini, Antonio; Koutrakis, PetrosBackground: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. Methods: We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. Results: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1–2.3) and 9.1 (95% eCI, 8.9–9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4–2.8) and 12.8 (95% eCI, 12.2–13.1) for every 1000 heart failure deaths, respectively. Conclusions: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day—and especially under a changing climate.
- (Bio)monitoring Wildland Firefighters’ Occupational ExposurePublication . Esteves, Filipa; Madureira, Joana; Teixeira, João Paulo; Costa, SolangeBio4FOX main goals are to a) characterize firefighter’s occupational activities and behaviours through questionnaires; b) assess personal exposure levels to health-relevant hazardous pollutants through metabolites in exhaled air; c) evaluate early effects at molecular and cellular levels in systemic and local-target tissues and d) integrate data for a comprehensive assessment of firefighter’s occupational exposure and related health impacts. The study will comprise three different phases (pre-exposure, during exposure, and post-exposure to fire season).