Browsing by Author "Ramos, Elisabete"
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- Children's health and indoor air quality in primary schools and homes in Portugal-Study designPublication . Madureira, Joana; Paciência, Inês; Ramos, Elisabete; Barros, Henrique; Pereira, Cristiana; Teixeira, João Paulo; Fernandes, Eduardo de OliveiraThe 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.
- Indoor air quality in schools and its relationship with children's respiratory symptomsPublication . Madureira, Joana; Paciência, Inês; Rufo, João; Ramos, Elisabete; Barros, Henrique; Teixeira, João Paulo; de Oliveira Fernandes, EduardoA 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.
- Inquérito Alimentar Nacional e de Atividade Física, IAN-AF 2015-2016: relatório de resultadosPublication . Lopes, Carla; Torres, Duarte; Oliveira, Andreia; Severo, Milton; Alarcão, Violeta; Guiomar, Sofia; Mota, Jorge; Teixeira, Pedro; Rodrigues, Sara; Lobato, Liliane; Magalhães, Vânia; Correia, Daniela; Carvalho, Catarina; Pizarro, Andreia; Marques, Adilson; Vilela, Sofia; Oliveira, Luísa; Nicola, Paulo; Soares, Simão; Ramos, ElisabeteEste relatório foi realizado com informação recolhida no âmbito do Inquérito Alimentar Nacional e de Atividade Física (IAN-AF 2015-2016), desenvolvido por um Consórcio que tem como Promotor a Universidade do Porto. O IAN-AF recebeu financiamento do Espaço Económico Europeu concedido pela Islândia, Liechtenstein e Noruega através do Programa EEA Grants - Iniciativas de Saúde Pública, área dos Sistemas de Informação em Saúde (PT06 - 000088SI3). O IAN-AF teve o apoio institucional da Direção-Geral da Saúde, da Administração Central do Sistema de Saúde, das Administrações Regionais de Saúde, das Secretarias Regionais de Saúde dos Açores e da Madeira e da Autoridade Europeia para a Segurança dos Alimentos.
- Inquérito Alimentar Nacional e de Atividade Física, IAN-AF 2015-2016: relatório metodológicoPublication . Lopes, Carla; Torres, Duarte; Oliveira, Andreia; Severo, Milton; Alarcão, Violeta; Guiomar, Sofia; Mota, Jorge; Teixeira, Pedro; Ramos, Elisabete; Rodrigues, Sara; Vilela, Sofia; Oliveira, Luísa; Nicola, Paulo; Soares, Simão; Frost Andersen, Lene; Consórcio IAN-AFO Inquérito Alimentar Nacional e de Atividade Física (IAN-AF) 2015-2016 teve como objetivo primário recolher informação de representatividade nacional e regional (dos 3 meses aos 84 anos de idade) sobre o consumo alimentar (incluindo a ingestão e suplementação nutricionais, a segurança dos alimentos e a insegurança alimentar) e sobre a atividade física (incluindo os comportamentos sedentários, as atividades desportivas/de lazer e as escolhas ativas na rotina diária) e a sua relação com determinantes em saúde, nomeadamente os socioeconómicos. O projeto foi desenvolvido por um Consórcio, envolvendo investigadores da Universidade do Porto (Promotor), da Universidade de Lisboa, do Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), da Universidade de Oslo e da empresa SilicoLife. Os participantes foram selecionados aleatoriamente por um processo de amostragem bietápica, a partir do Registo Nacional de Utentes do Serviço Nacional de Saúde: i) seleção aleatória de Unidades Funcionais de Saúde em cada Unidade Territorial para Fins Estatísticos (NUTS II), ponderada para o número de inscritos; ii) seleção aleatória de indivíduos registados em cada Unidade Funcional de Saúde, com um número fixo de elementos por sexo e grupo etário. Avaliaram-se 6553 participantes através de uma entrevista presencial e destes, 5811 completaram as duas entrevistas previstas, intervaladas no tempo entre 8 a 15 dias e distribuídas ao longo de 12 meses (outubro de 2015 a setembro de 2016), incluindo as quatro estações do ano e todos os dias da semana, de forma a ajustar para a variabilidade intra-individual e para a sazonalidade dos comportamentos alimentares e de atividade física. A metodologia utilizada incluiu ferramentas e protocolos harmonizados no contexto Europeu, de acordo com o definido no inquérito pan-Europeu EU-MENU, promovido pela Autoridade Europeia para a Segurança dos Alimentos (EFSA), integrados numa plataforma eletrónica assistida por computador, especificamente desenvolvida (Plataforma “You eAT&Move”). O Módulo “You” permite a recolha de informação sociodemográfica, de saúde geral, de antropometria, de propensão alimentar e de insegurança alimentar. Os parâmetros antropométricos (peso, estatura, perímetros do braço, cintura e anca) foram objetivamente medidos de acordo com procedimentos padronizados. A insegurança alimentar foi avaliada através de uma adaptação do questionário desenvolvido por Cornell/Radimer (1990), que fornece estimativas a nível nacional de insegurança alimentar, para as famílias, com e sem menores de 18 anos, recolhendo informação sobre quatro dimensões subjacentes à experiência de insegurança alimentar: disponibilidade, acesso, utilização e estabilidade/resiliência. O módulo “eAT24” permite a recolha de informação alimentar através de dois questionários às 24 horas anteriores (ou diários alimentares de dois dias nas crianças com idade <10 anos), sincronizada com dados de composição nutricional dos alimentos e receitas da Tabela da Composição de Alimentos Portuguesa (INSA), adaptada. A quantificação de porções alimentares incluiu um manual fotográfico especificamente desenvolvido para o efeito (1006 fotos de alimentos e receitas e 11 fotos de medidas caseiras). A classificação e descrição dos alimentos foram realizadas com base no sistema FoodEx2. Esta informação permite caracterizar as dimensões de consumo alimentar e nutricional e de segurança dos alimentos. O módulo “Move” permite a recolha de informação de atividade física e inclui os sub-módulos International Physical Activity Questionnaire (IPAQ), Activity Choice Index (ACI) (≥ 15 anos) e diários de atividade física de 4 dias (2 dias consecutivos e 2 dias de fim de semana) em crianças e adolescentes (6-14 anos), sincronizados com os dados de equivalentes metabólicos associados aos diferentes tipos de atividades. Esta informação permite caracterizar as dimensões de comportamentos sedentários, atividades desportivas e escolhas ativas na rotina diária. A criação de evidência nacional, desagregada por áreas geográficas, para diferentes grupos populacionais (crianças, adolescentes, adultos, idosos), constitui uma base descritiva essencial para o planeamento em saúde. O conhecimento produzido pelo IAN-AF 2015- 2016 permite dar resposta a prioridades estratégicas em saúde, nacionais e internacionais, e constitui uma base sólida para o desenvolvimento de políticas de educação alimentar e de atividade física, bem como de políticas de segurança alimentar, em Portugal e na União Europeia.
- National Food, Nutrition and Physical Activity Survey of the Portuguese general populationPublication . Lopes, Carla; Torres, Duarte; Oliveira, Andreia; Severo, Milton; Guiomar, Sofia; Alarcão, Violeta; Vilela, Sofia; Ramos, Elisabete; Rodrigues, Sara; Oliveira, Luísa; Nicola, Paulo; Mota, Jorge; Teixeira, Pedro; Soares, SimãoThe National Food, Nutrition and Physical Activity Survey of the Portuguese general population aimed to collect nationwide and regional data on dietary intake and physical activity, and their relation with health determinants, namely socioeconomic factors. Results from this project were obtained from a representative sample of the Portuguese population, aged between three months to 84 years of age, selected from the National Heath Registry, by multistage sampling (a sample size of 5068 individuals was estimated and 5811 participants with two dietary assessments were achieved). To accomplish the EFSA requirements, a minimum, of 260 individuals in each age group (130 by sex) was planned. Two face-to-face interviews were conducted at a health care centre or participant’s home. Dietary intake was obtained by two non-consecutive days of food diaries for children (<10 years old) and two non-consecutive 24-hours recalls for the older age groups, with a time interval between 8 and 15 days, complemented with a Food Propensity Questionnaire. An electronic platform based on a client-server architecture was used to manage the field work and to assist the data collection. The Electronic Assessment Tool for 24-hours recall (eAT24) allowed the collection of dietary data by an Automated Multiple-Pass Method for 24-hours. This interview-based dietary assessment instrument allowed obtaining a very detailed description and quantification of foods, recipes, and food supplements consumed in the course of the preceding day, and it had several adaptations, described in detail in this report. The survey outcomes support solid evidence-based information covering all age groups of the population, using harmonized methodologies at the European level, and will contribute to develop a national infrastructure for monitoring progress of specific targets supporting national and European policies and future interventions on diet, physical activity and food safety.
- National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015-2016): Protocol for Design and DevelopmentPublication . Lopes, Carla; Torres, Duarte; Oliveira, Andreia; Severo, Milton; Guiomar, Sofia; Alarcão, Violeta; Ramos, Elisabete; Rodrigues, Sara; Vilela, Sofia; Oliveira, Luísa; Mota, Jorge; Teixeira, Pedro J; Nicola, Paulo J; Soares, Simão; Andersen, Lene Frost; IAN-AF ConsortiumBACKGROUND: The assessment of food consumption data using harmonized methodologies at the European level is fundamental to support the development of public policies. Portugal is one of the countries with the most outdated information on individual foodconsumption. OBJECTIVE: The objective of this study was to describe the design and methodology of the National Food, Nutrition and Physical ActivitySurvey, 2015-2016, developed to collect national and regional data on dietary habits, physical activity (PA), and nutritional status, in a representative sample of the Portuguese general population (3 months-84 years). METHODS: Participants were selected by multistage sampling, using the National Heath Registry as the sampling frame. Data collection, during 12 months, was harmonized according to European guidelines (EU-MENU, European Food Safety Authority [EFSA]). Computer-assisted personal interviewing (CAPI) was performed on a specific electronic platform synchronized with nutritional composition data and considering the FoodEx2 classification system. Dietary assessment was performed using 24-hour recalls (two nonconsecutive, 8-15 days apart) or food diaries in the case of children aged <10 years, complemented with a food propensity questionnaire; PA data (International Physical Activity Questionnaire [IPAQ], the Activity Choice Index [ACI], and 4-days PA diaries); sociodemographic data, and other health-related data were also collected. RESULTS: A sample of 6553 individuals completed the first interview, and 5811 participants completed two dietary assessments. The participation rate among eligible individuals was 33.38% (6553/19,635), considering the first interview, and 29.60% (5811/19,635) for the participants with two completed interviews (about 40% in children and adolescents and 20% in elderly individuals). Results of the survey will be disseminated in national and international scientific journals during 2018-2019. CONCLUSIONS: The survey will assist policy planning and management of national and European health programs on the improvement of nutritional status and risk assessment related to food hazards, and the enhancement of PA. The infrastructures and data driven from this Survey are a solid basis to the development of a future national surveillance system on diet, PA, and other health behaviors reproducible over time.
- Prevalence of general and abdominal obesity in Portugal: comprehensive results from the National Food, nutrition and physical activity survey 2015-2016Publication . Oliveira, Andreia; Araújo, Joana; Severo, Milton; Correia, Daniela; Ramos, Elisabete; Torres, Duarte; Lopes, Carla; by the IAN-AF ConsortiumBACKGROUND: This study includes, for the first time, estimates of general and abdominal obesity prevalence for all ages of the Portuguese population, using common standardized methodologies. Results are compared by sex, age groups, educational level and geographical regions. METHODS: Participants were a representative sample of the Portuguese population aged between 3 months and 84 years of age (n = 6553), enrolled in the National Food, Nutrition and Physical Activity Survey, 2015-2016. Objective anthropometric measurements included length/height, weight and body circumferences, performed according to standard procedures. Body mass index (BMI) was classified according to the World Health Organization (WHO) growth charts for children and adolescents, and WHO criteria for adults. Abdominal obesity was defined in adults as waist-hip ratio ≥ 0.85 in women or ≥ 0.90 in men. Prevalence estimates and 95% confidence intervals (95%CI) were weighted according to a complex sampling design, considering stratification by seven geographical regions and cluster effect for the selected Primary Health Care Unit. RESULTS: The national prevalence of obesity is 22.3% (95%CI: 20.5-24.0), significantly higher in women. Obesity prevalence is much higher in the elderly (39.2%, 95%CI. 34.2-44.2), while children and adolescents have the lowest prevalence around 8-9%. In a regression model, three knot points denoting an inflection of obesity prevalence across the life span were observed around 5, 15 and 75 years. The prevalence of pre-obesity at national level is 34.8% (95%CI: 32.9-36.7), higher in men, and almost 18% of children and 24% of adolescents have pre-obesity. The sex- and age-standardized prevalence of obesity ranged from 38.3% (95%CI: 34.6-42.1) to 13.1% (95%CI: 10.3-15.9) for the less and the most educated individuals, respectively. Although some geographical region disparities, obesity prevalence did not significantly differed across regions (p = 0.094). The national prevalence of abdominal obesity in adults is 50.5% (95%CI: 47.9-53.1), particularly high in the elderly (80.2%). CONCLUSION: Almost 60% of the general Portuguese population is obese or pre-obese. Women, elderly and less educated individuals present the highest obesity prevalence. Abdominal obesity, in particular, seems to be a relevant public health problem among the elderly men.