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- Indoor Air Quality in Primary SchoolsPublication . Freitas, Maria do Carmo; Canha, Nuno; Martinho, Maria; Almeida-Silva, Marina; Almeida, Susana Marta; Pegas, Priscilla; Alves, Célia; Pio, Casimiro; Trancoso, Maria; Sousa, Rita; Mouro, Filomena; Contreiras, TeresaClean air is a basic requirement of life (World Health Organization, 2010). The Indoor Air Quality (IAQ) has been the object of several studies due to an increasing concern within the scientific community on the effects of indoor air quality upon health, especially as people tend to spend more time indoors than outdoors (Franck et al., 2011; Canha et al., 2010; WHO, 2010; Environmental Protection Agency, 2010; Saliba et al., 2009; Fraga et al., 2008; Fromme et al., 2007; Guo et al., 2004; Kosonen, 2004; Lee et al., 2002a; Lee et al., 2002b; Carrer et al., 2002; Lee et al., 2001; Li et al., 2001; Wilson & Spengler, 1996; Allen & Miguel, 1995; Jenkins et al., 1992; WHO, n.d.). The quality of air inside homes, offices, schools or other private and public buildings is an essential determinant of healthy life and people’s well-being (WHO, 2010). People can be exposed to contaminants by inhalation, ingestion and dermal contact. In the past, scientists have paid much attention to the study of exposure to outdoor air contaminants, because they have realised the seriousness of outdoor air pollution problems. However, each indoor microenvironment has unique characteristics, determined by the local outdoor air, specific building characteristics and indoor activities (Pegas et al, 2010). Indeed, hazardous substances are emitted from buildings, construction materials and indoor equipment or due to human activities indoors (WHO, 2010; Carrer et al., 2002). Reports about buildings with air-related problems have received increasing attention since the 1970s (Spengler & Sexton, 1983; Hodgson, 1992). In an indoor environment, dust on floors and other surfaces contains minerals, metals, fibres from textiles, paper, and insulation material, particles from tobacco smoke, including polycyclic aromatic compounds (PAH’s). For this reason, the indoor environment is cleaned to maintain an acceptable level of perceived cleanliness, to prevent surface degradation, to control potential risk of infection from microorganisms, and to control dust exposure in general (Wolkoff et al., 1998). All of these pollutants could cause significant damage to health globally (WHO, 2010).The IAQ in school buildings is expected to be a key role player in the assessment of the effects of the children personal exposure to air pollution as children spend at least a third of their time inside school buildings, that is, approximately seven or more hours a day in school (Almeida et al., 2010; EPA, 2010; Pegas et al., 2010; Wheeler et al., 2009; Ramachandran et al., 2005). Poor IAQ can affect scholarly performance and attendance (Daisey et al. 2003; Godoi et al. 2009). Hence, several studies about air quality in schools have recently been published (Goyal & Khare, 2009; Tippayawong et al., 2009; Fraga et al., 2008; Fromme et al., 2007; Hwang et al., 2006). Environmental asthma triggers commonly found in school buildings include respiratory viruses; cockroaches and other pests; mold resulting from excess moisture in the building; dander from animals in the classroom; and dander brought on the clothing from animals at home. Second-hand smoke and dust mites are other known environmental asthma triggers found in schools. Children with asthma may be affected by other pollutants from sources inside schools, such as unvented stoves or heaters and common products including chemicals, cleaning agents, perfumes, pesticides and sprays. Indoor Air Quality problems in schools may be even more serious than in other categories of buildings, due to higher occupant density and insufficient outside air supply, aggravated by frequent poor construction and/or maintenance of school buildings (Pegas et al., 2010). Schools are seen as particularly likely to have environmental deficiencies because chronic shortages of funding contribute to inadequate operation and maintenance of facilities (Mendell & Heath, 2005). Previous studies showed the poor indoor environmental quality at schools may be explained by: (1) insufficient ventilation in schools, specially in winter, (2) infrequently and not thoroughly cleaned indoor surfaces, and (3) a large number of students in relation to room area and volume, with constant re-suspension of particles from room surfaces (Janssen et al., 1999). Children constitute a sensitive group with higher risk than adults (Stranger et al., 2007a) because children are particularly vulnerable to pollutants due to their undeveloped airways (Stranger et al., 2007a; Mendell et al., 2005). Moreover, children have greater susceptibility to some environmental pollutants than adults, because they breathe higher volumes of air relative to their body weights and their tissues and organs are actively growing (Mendell & Heath, 2005). The effects of air pollution on children have been growing (Khan et al., 2007) and one of the consequences is the increase of the prevalence of allergic rhinitis (ISAAC, 1998). The chemical and microbiological parameters required by the Portuguese Legislation for IAQ monitoring purposes are: carbon dioxide (CO2), carbon monoxide (CO), ozone (O3), formaldehyde (HCHO), volatiles organic compound (VOCs), bacteria and fungi (DL n.º 79/2006).
- National Public Health Institutes: European perspectivePublication . Huttunen, Jussi; Puska, Pekka; Burger, Reinhard; McCracken, Justin; Miguel, Jose Pereira; Seljak, Marija; Stene-Larsen, Geir; Wilde, Jane; Wamala, Sarah
- Variants in the inflammatory IL6 and MPO genes modulate stroke susceptibility through main effects and gene-gene interactionsPublication . Manso, Helena; Krug, Tiago; Sobral, João; Albergaria, Isabel; Gaspar, Gisela; Ferro, José M.; Oliveira, Sofia A.; Vicente, A.M.There is substantial evidence that inflammation within the central nervous system contributes to stroke risk and recovery. Inflammatory conditions increase stroke risk, and the inflammatory response is of major importance in recovery and healing processes after stroke. We investigated the role of inflammatory genes IL1B, IL6, MPO, and TNF in stroke susceptibility and recovery in a population sample of 672 patients and 530 controls, adjusting for demographic, clinical and lifestyle risk factors, and stroke severity parameters. We also considered the likely complexity of inflammatory mechanisms in stroke, by assessing the combined effects of multiple genes. Two interleukin 6 (IL6) and one myeloperoxidase (MPO) single-nucleotide polymorphisms were significantly associated with stroke risk (0.022<(corrected)P<0.042), highlighting gene variants of low to moderate effect in stroke risk. An epistatic interaction between the IL6 and MPO genes was also identified in association with stroke susceptibility (P=0.031 after 1,000 permutations). In a subset of 546 patients, one IL6 haplotype was associated with stroke outcome at 3 months ((corrected)P=0.024), an intriguing finding warranting further validation. Our findings support the association of the IL6 gene and present novel evidence for the involvement of MPO in stroke susceptibility, suggesting a modulation of stroke risk by main gene effects, clinical and lifestyle factors, and gene-gene interactions.
- Role of 13C-urea breath test in experimental model of Helicobacter pylori infection in micePublication . Santos, António Mário; Lopes, Teresa; Oleastro, Mónica; Chaves, Paula; Cordeiro, Rita; Ferreira, Maria; Pereira, Teresa; Machado, Jorge; Guerreiro, António SousaBACKGROUND: Animal models have been widely used to study Helicobacter pylori infection. Evaluation of H. pylori infection status following experimental inoculation of mice usually requires euthanasia. The (13) C-urea breath test ((13) C-UBT) is both sensitive and specific for detection of H. pylori in humans. Thus, it would be very useful to have such a test with the same accuracy for the follow-up of this infection in animal models of gastric infection. Accordingly, the purpose of this study was to develop and evaluate a (13) C-UBT method for following the course of H. pylori infection in a mouse model. MATERIAL AND METHODS: A total of 50 female C57BL/6 mice were gavaged three times with either 10(8) colony-forming units of H. pylori (n=29) or saline solution only (n=21). After 2 months of infection, mice were fasted for 14 hours and (13) C-UBT was performed using 300 μg of (13) C-urea. The mice were killed, and the stomach was removed and processed for immunohistochemistry and PCR. RESULTS: The optimal time for breath sample collection in mice was found to be 15 minutes. The (13) C-UBT cutoff was set at 3.0‰ δPDB. Using PCR as the gold standard, the sensitivity of (13) C-UBT and immunohistochemistry was 96.6 and 72.4%, respectively, while the specificity was 85.7 and 95.2%, respectively. CONCLUSIONS: (13) C-UBT was shown to be a reliable method for the detection of H. pylori infection in C57BL/6 mice and was even more accurate than immunohistochemistry. The use of (13) C-UBT in the mouse model of H. pylori infection can be very useful to detect the bacterium without the need to kill the animals in long-term time course studies.
- First annual Meeting Report: meeting of the European Diphtheria Surveillance Network, Stockholm, 17 March 2011Publication . European Center for Disease Control and PreventionOn 17 March 2011, 37 disease and surveillance experts met in Stockholm for the first annual meeting of the European Diphtheria Surveillance Network (EDSN). Discussed topics included the lack of appropriate treatment with diphtheria antitoxin, the increasing susceptibility to the disease of older people, and the importance of the resumption of seroprevalence studies.
- Prevalence of Human Papillomavirus Infection in Women in Portugal - The CLEOPATRE Portugal StudyPublication . Pista, Angela; Oliveira, Carlos; Cunha, Maria João; Paixão, Teresa; Real, Odete; CLEOPATRE Portugal Study GroupObjective: Human papillomavirus (HPV) is responsible for a range of diseases, including cervical cancer. The primary objectives of the CLEOPATRE Portugal study were to estimate the overall and age-stratified prevalence of cervical HPV infection, and to assess HPV prevalence and type-specific distribution by cytological results, among women aged 18–64 years resident in mainland Portugal. Methods/materials: This cross-sectional, population-based study recruited women aged 18–64 years, according to an age-stratified sampling strategy, who attended gynaecology/obstetrics or sexually transmitted disease clinics across the five Regional Health Administrations in mainland Portugal between 2008 and 2009. Liquid-based cytology samples were collected and analysed centrally for HPV genotyping (Clinical Array HPV 2 assay) and cytology. Prevalence estimates were adjusted for age using 2007 Portuguese census data. Results: A total of 2326 women were included in the study. The overall prevalence of HPV infection in the study was 19.4% (95% CI, 17.8–21.0), with the highest prevalence in women aged 18–24 years. High-risk HPV types were detected in 76.5% of infections, of which 36.6% involved multiple types. The commonest high-risk type was HPV 16. At least one of the HPV types 6/11/16/18 was detected in 32.6% of infections. The HPV prevalence in normal cytology samples was 16.5%. There was a statistically significant association between high-risk infection and cytological abnormalities (p<0.001). Conclusions: This is the first population-based study to quantify and describe cervical HPV infection in mainland Portugal. This study provides baseline data for future assessment of the impact of HPV vaccination programmes.
- Unverricht–lundborg disease: report of a new mutationPublication . Freitas, Joel; Pinto, Eugénia; Duarte, A.J.; Amaral, Olga; Chaves, Joao; Lopes-Lima, J.P301: Unverricht-Lundborg disease is the most frequent cause of progressive myoclonic epilepsy. CSTB mutations, with cystatin B loss of function, have been described as the major cause of this disease.
- Vacinação antigripal da população portuguesa, em 2010-2011: cobertura e algumas caracterísitcas do acto vacinalPublication . Branco, Maria João; Nunes, BaltazarIntrodução: Dando continuidade ao trabalho desenvolvido desde a época de 1998-1999, o Instituto Nacional de Saúde Dr. Ricardo Jorge, através do Departamento de Epidemiologia, estudou a cobertura da vacinação anti-gripal na época de 2010-2011. Objectivo: i) Estimar a cobertura vacinal contra a gripe sazonal (VAGS) na época gripal de 2010-2011, na população do Continente; ii) Caracterizar a prática da VAGS, relativamente a alguns factores, nomeadamente, iniciativa de vacinação, local de vacinação, calendário de vacinação, atitude face à vacina; Metodologia: O estudo, descritivo transversal, constou de um inquérito realizado por entrevista telefónica à amostra de famílias ECOS, em Fevereiro 2011. Esta amostra é aleatória e constituída por 1074 Unidades de Alojamento (UAs), contactáveis por telefone fixo e móvel, estratificada por Região NUT II do Continente, com alocação homogénea. Estas unidades de alojamento representaram 3208 indivíduos. Em cada agregado, foi inquirido apenas um elemento com 18 ou mais anos que prestou informação sobre si próprio e sobre os restantes elementos do agregado. A recolha de dados foi feita através da aplicação de um questionário de 12 perguntas. As variáveis colhidas contemplaram a caracterização dos inquiridos, nomeadamente, no que diz respeito à i) VAGS na época 2010-2011: iniciativa, mês de vacinação, local, motivos para não vacinação, percepção dos não vacinados face à vacina; ii) morbilidade por “gripe”: auto-declarada, sintomas e sinais, confirmação laboratorial As questões referentes à cobertura da VAGS foram semelhantes às utilizadas nos questionários aplicados nas épocas anteriores, afim de se poder comparar resultados. Resultados: Obtiveram-se 903 questionários válidos, o que corresponde a uma taxa de resposta de 84,1%. Através dos respondentes, um por alojamento, obtiveram-se dados sobre 2710 indivíduos residentes naquelas UA, correspondendo a 84,5% do total de indivíduos existentes nas UA da amostra. A cobertura da VAGS na época de 2010-2011atingiu o valor de 17,5% (IC95%: 15,1%; 20,3%). A cobertura nos grupos de risco foi: 48,3% (IC95%: 40,9%-55,7%), nos indivíduos de 65 anos; 28,8% (IC95%: 24,8%-33,2%), nos portadores de pelo menos uma doença crónica. A vacinação antigripal sazonal ocorreu, quase totalmente, até final de Novembro: (95,9%: IC95%: 89,7%-98,5%); fundamentalmente, por indicação do Médico de Família: 67,7% (IC95%: 59,6%-74,9%); para se vacinarem utilizam essencialmente a farmácia: 42,4% (IC95%: 31,9%-53,5%), seguida do Centro de Saúde: 25,8% (IC95%: 17,5%-36,2%). O principal conjunto de razões invocadas para a recusa da vacinação sazonal relaciona-se com mecanismos de desvalorização/negação da importância da doença: 52,8% (IC95%: 47,8%-57,8%). Discussão/conclusões: Afigura-se importante continuar a promover uma maior cobertura com a vacina antigripal dos indivíduos com 65 anos e mais (Portugal assumiu a meta de 75% de cobertura da população idosa e de risco de complicações, para a época 2014-15), assim como no grupo de indivíduos portadores de alguma doença crónica para a qual se recomenda a vacinação.
- Ascorbic acid content in exotic fruits: A contribution to produce quality data for food composition databasesPublication . Valente, A.; Albuquerque, T.G.; Sanches-Silva, A.; Costa, H.S.Ascorbic acid (AA) is a water-soluble vitamin mainly present in fruits and vegetables. Food Composition Databases (FCDB) provide detailed information on nutritionally important components in foods. However, in some FCDB there is a significant lack of information on vitamin C content. The aim of this study is to produce new data for FCDB by measuring the AA content in 26 types of exotic fruits and to evaluate the nutritional value of these fruits as a source of vitamin C. In this study, the analytical method used to measure ascorbic acid content is an economic, rapid and previously validated High Performance Liquid Chromatography (HPLC) method. Ascorbic acid content per 100 g of edible portion ranged between 0.925 ± 0.018 mg for kiwano and 117 ± 1.64 mg for arbutus. For all the analyzed exotic fruits and considering a mean daily consumption of 100 g/day, twelve of them provide more than 30% of the Dietary Reference Intake. About a quarter of the analyzed exotic fruits are not found in any of the five FCDB considered in this study. The worldwide global market is expanding the production and consumption of fresh fruits and vegetables, mostly exotic, increasing the need of updating the food composition databases with high quality data. The analytical results obtained in this study are an important source of reliable data to be included in the Portuguese food composition database.
- Isolates from hospital environments are the most virulent of the Candida parapsilosis complexPublication . Sabino, Raquel; Sampaio, Paula; Carneiro, Catarina; Rosado, Laura; Pais, CéliaBackground: Candida parapsilosis is frequently isolated from hospital environments, like air and surfaces, and causes serious nosocomial infections. Molecular studies provided evidence of great genetic diversity within the C. parapsilosis species complex but, despite their growing importance as pathogens, little is known about their potential to cause disease, particularly their interactions with phagocytes. In this study, clinical and environmental C. parapsilosis isolates, and strains of the related species C. orthopsilosis and C. metapsilosis were assayed for their ability to induce macrophage cytotocixity and secretion of the pro-inflammatory cytokine TNF-a, to produce pseudo-hyphae and to secrete hydrolytic enzymes. Results: Environmental C. parapsilosis isolates caused a statistically significant (p = 0.0002) higher cell damage compared with the clinical strains, while C. orthopsilosis and C. metapsilosis were less cytotoxic. On the other hand, clinical isolates induced a higher TNF-a production compared with environmental strains (p < 0.0001). Whereas the amount of TNF-a produced in response to C. orthopsilosis strains was similar to the obtained with C. parapsilosis environmental isolates, it was lower for C. metapsilosis strains. No correlation between pseudo-hyphae formation or proteolytic enzymes secretion and macrophage death was detected (p > 0.05). However, a positive correlation between pseudo-hyphae formation and TNF-a secretion was observed (p = 0.0119). Conclusions: We show that environmental C. parapsilosis strains are more resistant to phagocytic host defences than bloodstream isolates, being potentially more deleterious in the course of infection than strains from a clinical source. Thus, active environmental surveillance and application of strict cleaning procedures should be implemented in order to prevent cross-infection and hospital outbreaks.