ALFESIO LUIS FERREIRA BRAGA
Projetos de Pesquisa
Unidades Organizacionais
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Influence of environmental contamination on pregnancy outcomes(2015) GUIMARAES, Mariana Tavares; CUNHA, Michele Granato; CARVALHO, Daniele Pena; RIBEIRO, Tatyana Sampaio; MARTINS, Lourdes Conceicao; BRAGA, Alfesio Luis Ferreira; PEREIRA, Luiz Alberto AmadorThis study aims to compare pregnancy outcomes in four contaminated areas to those observed in a non-contaminated area of similar socioeconomic status. A cross-sectional study was carried out. A structured and pre-tested questionnaire was administered to population-based samples of 788-920 families in each of the five studied areas. The exposure assessment used was an ecological measure. Using logistic regression, odds of several pregnancies outcomes (pregnancy occurrence, miscarriage, stillbirth, prematurity, low birth weight, congenital malformation, and multiple births) were estimated after adjustment for potential confounders such as socioeconomic, demographic, and substance abuse factors. We adopted a statistical significance level of 5 %. In three of the four exposed areas, pregnancy occurrence was reduced in comparison to the control area (Area 2, odds ratio (OR) = 0.68, 95 % CI = 0.54-0.86; Area 3, OR = 0.76, 95 % CI = 0.60-0.97; Area 4, OR = 0.71, 95 % CI = 0.56-0.90). Also, a significantly increased odds of miscarriage for living in Area 3 (OR = 1.83, 95 % CI = 1.07-3.12) was found. The other pregnancy outcomes were not significantly elevated in the exposed areas. In conclusion, this study shows evidence of reduced pregnancy occurrence and increased miscarriage occurrence in some of the contaminated areas, compared to the control area.
- Ambient levels of air pollution induce clinical worsening of blepharitis(2012) MALERBI, Fernando Korn; MARTINS, Lourdes Conceicao; SALDIVA, Paulo Hilario Nascimento; BRAGA, Alfesio Luis FerreiraBackground: Even though air pollutants exposure is associated with changes in the ocular surface and tear film, its relationship to the clinical course of blepharitis, a common eyelid disease, had not yet been investigated. Our objective was to investigate the correlation between air pollution and acute manifestations of blepharitis. Method: We recorded all cases of changes in the eyelids and ocular surface, and rated clinical findings on a scale from zero (normal) to two (severe alterations). Daily values of carbon monoxide, particulate matter smaller than 10 mu m in diameter and nitrogen dioxide concentrations and meteorological variables (temperature and relative humidity) in the vicinity of the medical service were obtained. Specific linear regression models for each outcome were constructed including pollutants as independent variables (single pollutant models). Temperature and humidity were included as confounding variables. Results: increases of 28.8 mu g/m(3) in the concentration of particulate matter and 1.1 ppm in the concentration of CO were associated with increases in cases of blepharitis on the day of exposure (5 cases, 95% CI: 1-10 and 6 cases, 95% CI: 1-12, respectively). Conclusion: Exposure to usual air pollutants concentrations present in large cities affects, in a consistent manner, the eyes of residents contributing to the increasing incidence of diseases of the eyelid margin.
- A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture(2015) PAI, Hong Jin; AZEVEDO, Raymundo Soares; BRAGA, Alfesio Luis Ferreira; MARTINS, Lourdes Conceicao; SARAIVA-ROMANHOLO, Beatriz M.; MARTINS, Milton de Arruda; LIN, Chin AnOBJECTIVES: This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma. METHODS: This was a randomized, controlled, crossover trial conducted at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. A total of 74 patients withmild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short-and long-acting beta-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (alpha=0.05). RESULTS: In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation. CONCLUSION: Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.
- The association between air pollution and blood pressure in traffic controllers in Santo Andre, Sao Paulo, Brazil(2011) CHIARELLI, Paulo Sergio; PEREIRA, Luiz Alberto Amador; SALDIVA, Paulo Hilario do Nascimento; FERREIRA FILHO, Celso; GARCIA, Maria Lucia Bueno; BRAGA, Alfesio Luis Ferreira; MARTINS, Lourdes ConceicaoBackground: Urban air pollutants are associated with cardiovascular events. Traffic controllers are at high risk for pollution exposure during outdoor work shifts. Objective: The purpose of this study was to evaluate the relationship between air pollution and systemic blood pressure in traffic controllers during their work shifts. Methods: This cross-sectional study enrolled 19 male traffic controllers from Santo Andre city (Sao Paulo, Brazil) who were 30-60 years old and exposed to ambient air during outdoor work shifts. Systolic and diastolic blood pressure readings were measured every 15 min by an Ambulatory Arterial Blood Pressure Monitoring device. Hourly measurements (lags of 0-5 h) and the moving averages (2-5 h) of particulate matter (PM(10)), ozone (O(3)) ambient concentrations and the acquired daily minimum temperature and humidity means from the Sao Paulo State Environmental Agency were correlated with both systolic and diastolic blood pressures. Statistical methods included descriptive analysis and linear mixed effect models adjusted for temperature, humidity, work periods and time of day. Results: Interquartile increases of PM(10) (33 mu g/m(3)) and O(3) (49 mu g/m(3)) levels were associated with increases in all arterial pressure parameters, ranging from 1.06 to 2.53 mmHg. PM(10) concentration was associated with early effects (lag 0), mainly on systolic blood pressure. However, O(3) was weakly associated most consistently with diastolic blood pressure and with late cumulative effects. Conclusions: Santo Andre traffic controllers presented higher blood pressure readings while working their outdoor shifts during periods of exposure to ambient pollutant fluctuations. However, PM(10) and O(3) induced cardiovascular effects demonstrated different time courses and end-point behaviors and probably acted through different mechanisms.
conferenceObject Inflammation in traffic professional from Sao Paulo after pollutants emission control implementation(2012) GARCIA, Maria Lucia Bueno; MARTINS, Lourdes Conceicao; BRAGA, Alfesio; LEMOS, Miriam; PEREIRA, Luis; AFONSO, Paulo; SALDIVA, Paulo; UBIRATAN, Paula Santos- Self-reported prevalence of asthma symptoms in adults living in a port city(2022) MATOS, Janara de Camargo; BOTELHO, Monica Luiza De Arruda; PAMPLONA, Ysabely De Aguiar Pontes; PEREIRA, Luiz Alberto Amador; BRAGA, Alfesio Luis Ferreira; MARTINS, Lourdes ConceicaoAir pollution is a worldwide health problem, and exposure to the pollution can cause damage to the human body, especially to the respiratory and cardiovascular systems. Asthma is the third most common chronic disease in Brazil, presenting high prevalence in some areas. The aim of this study was to evaluate the self-report the prevalence of asthma symptoms in Santos city, Brazil, and its associated factors in the adult population (between 18 and 59 years old). A cross-sectional study was applied in two different areas of the city. The participants of this study were selected by zip code estimated on a random sample. The ECHRS and a demographic questionnaire were used to collect data. Associations between categorical variables were tested using Pearson's chi-square test or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for asthma. Georeferencing was implemented to distribute the cases. The highest prevalence of asthma was found in Ponta da Praia neighborhood (16.4%; p=0.019), as well as waking up with a coughing crisis in the last 12 months (26.4%; p <0.001). The risk factors for asthma were the following: living next Santos Port area (OR: 2.90; 95%CI 1.13-7.44); and the presence of O-3 (OR = 2.63; 95%CI 0.86-7.96). This pioneering study demonstrated that living near the port area increases the chances of adults having self-reported asthma symptoms.
- Dental enamel as biomarker for environmental contaminants in relevant industrialized estuary areas in Sao Paulo, Brazil(2017) OLIVEIRA, Vera Lucia Ferreira de; GERLACH, Raquel Fernanda; MARTINS, Lourdes Conceicao; GUERRA, Carolina de Souza; FRAZAO, Paulo; BRAGA, Alfesio Luis Ferreira; PEREIRA, Luiz Alberto AmadorHeavy metal contamination is a long-standing and very well-known public health problem, and its exposure can cause damage to several organs of human body, especially on the central nervous system of young children and teenagers. The aim of this article is to evaluate lead, cadmium, and manganese contamination in 125 children from 6 to 13 years old living in contaminated areas during the period from 2006 to 2009 (Sao Vicente, Cubatao Downtown, Bertioga and Cubatao Piloes/Agua Fria). This estuary area is the most important example of environmental degradation by chemicals from industrial sources. This is a cross-sectional study through clinical examinations and dental enamel tests. All mothers from these children lived in the area since before the pregnancy. Lead, cadmium, and manganese levels (mu g/g) were measured on dental enamel samples through graphite furnace atomic absorption spectrometry, searching for the occurrence of heavy metals. The mean lead concentrations were 139.48 mu g/g in Cubatao Piloes/Agua Fria, 170.45 mu g/g in Cubatao Downtown, 213.52 mu g/g in Sao Vicente, and 151.89 mu g/g in Bertioga. The mean cadmium concentrations were 10.83 mu g/g in Cubatao Piloes/Agua Fria, 12.58 mu g/g in Cubatao Downtown, 10.92 mu g/g in Sao Vicente, and 14.57 mu g/g in Bertioga. The mean manganese concentrations were 23.49 mu g/g in Cubatao Piloes/Agua Fria, 30.90 mu g/g in Cubatao Downtown, 41.46 mu g/g in Sao Vicente, and 42.00 mu g/g in Bertioga. Dental surface enamel may be used as an efficient biomarker of past environmental exposure to lead, manganese, and cadmium which are associated to well-known sources of heavy metal contamination. The results suggest that the evaluated children were exposed to sources of lead, cadmium, and manganese since before their conceptions. Although Bertioga initially was chosen as a control area of this study, it was also was verified to have heavy metal contamination on examined children.
- Association between high-risk pregnancy and environmental contaminants in the Metropolitan Region of Baixada Santista, Brazil(2022) FERNANDES, Joice Maria Pacheco Antonio; PAMPLONA, Ysabely de Aguiar Pontes; VAZ, Jhonnes Alberto; PEREIRA, Amanda Rodrigues; BARBIERI, Carolina Luisa Alves; BRAGA, Alfesio Luis Ferreira; MARTINS, Lourdes ConceicaoThe Metropolitan Region of Baixada Santista (MRBS) is a highly contaminated area. High-risk pregnancy is one factor that leads to a higher chance of both morbidity and mortality of the mother-fetus binomial. The purpose of this study is to analyze the association between exposure to environmental contaminants and high-risk pregnancy. Case-control study, using a probabilistic and random sample composed of 201 high-risk pregnant women (cases) and 201 no high-risk pregnant women (control) followed up during prenatal care at a Public Hospital. The instrument used was a self-administered questionnaire. Contaminated areas data were obtained from the Environmental Company of the Sao Paulo State. The participants were georeferenced by their place of residence. Descriptive analysis, Chi-square test, and univariate and multiple logistic regression analysis were performed. The multiple logistic regression model demonstrated that living in a contaminated area (OR = 1.565; 95%CI: 1.033; 2.370), preterm delivery in the current pregnancy (OR = 1.989; 95%CI: 1.239; 3.194), and more than 35 years old (OR = 2.822; 95%CI: 1.692; 4.706) are factors jointly related to high-risk pregnancy. Environmental contaminants play an important role in high-risk pregnancy, and mitigating measures are needed to improve the environment and reduce high-risk pregnancy.
- A poluição do ar e o sistema respiratório(2012) ARBEX, Marcos Abdo; SANTOS, Ubiratan de Paula; MARTINS, Lourdes Conceicao; SALDIVA, Paulo Hilario Nascimento; PEREIRA, Luiz Alberto Amador; BRAGA, Alfesio Luis FerreiraOver the past 250 years since the Industrial Revolution accelerated the process of pollutant emission, which, until then, had been limited to the domestic use of fuels (mineral and vegetal) and intermittent volcanic emissions air pollution has been present in various scenarios. Today, approximately 50% of the people in the world live in cities and urban areas and are exposed to progressively higher levels of air pollutants. This is a non-systematic review on the different types and sources of air pollutants, as well as on the respiratory effects attributed to exposure to such contaminants. Aggravation of the symptoms of disease, together with increases in the demand for emergency treatment, the number of hospitalizations, and the number of deaths, can be attributed to particulate and gaseous pollutants, emitted by various sources. Chronic exposure to air pollutants not only causes decompensation of pre-existing diseases but also increases the number of new cases of asthma, COPD, and lung cancer, even in rural areas. Air pollutants now rival tobacco smoke as the leading risk factor for these diseases. We hope that we can impress upon pulmonologists and clinicians the relevance of investigating exposure to air pollutants and of recognizing this as a risk factor that should be taken into account in the adoption of best practices for the control of the acute decompensation of respiratory diseases and for maintenance treatment between exacerbations.
article 1 Citação(ões) na Scopus Maternal mortality profile in Great ABC Region from 1997 to 2005(2011) TOGNINI, Silvana; GARCIA, Maria Lucia Bueno; BRAGA, Alfesio Luis Ferreira; MARTINS, Lourdes ConceicaoMaternal mortality profile in Great ABC Region from 1997 to 2005 Objective: To analyze the maternal mortality in the ABC Region, comparing indicators from the Committee for the Study of Maternal Mortality in the Great ABC Region (CEMM) of the II Regional Health Center of Santo Andre (DIR II), and the State Data Analysis System Foundation (SEADE). Methods: This is a cross sectional study. The information was obtained from the database of CEMM DIR II Santo Andre, which includes data from seven counties of the ABC Region. We analyzed all deaths of childbearing-age women that occurred from 1997 to 2005 in that region. The paired t test, Wilcoxon and Kruskal-Wallis tests were used for statistical analysis. Results: There were differences regarding the maternal mortality rates in the towns of Diadema, Sao Bernardo do Campo, Santo Andre and DIR 11, with the coefficients calculated by CEMM being higher than those provided by the SEADE (p < 0.001). Concerning the towns of Maua, Rio Grande da Serra, Ribeirao Pires and Sao Caetano do Sul, no significant differences were observed between these two coefficients (p > 0.05), although the coefficients provided by CEMM were higher than the coefficients obtained from SEADE. Conclusion: Our results demonstrate that the official data of maternal mortality in Brazil are still underestimated and point to the lack of healthcare quality during pregnancy, childbirth and postpartum.