ALFESIO LUIS FERREIRA BRAGA
Projetos de Pesquisa
Unidades Organizacionais
LIM/05 - Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas, Faculdade de Medicina
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- Air pollution and low birth weight in an industrialized city in Southeastern Brazil, 2003-2006(2017) REIS, Marcelo Moreno dos; GUIMARÃES, Mariana Tavares; BRAGA, Alfésio Luís Ferreira; MARTINS, Lourdes Conceição; PEREIRA, Luiz Alberto AmadorABSTRACT: Introduction: Birth weight is an important indicator of several conditions that manifest earlier (as fetal and neonatal mortality and morbidity, inhibited growth and cognitive development) and later in life such as chronic diseases. Air pollution has been associated with adverse pregnancy outcomes. Objective: Retrospective cohort study investigated the association between low birth weight (LBW) and maternal exposure to air pollutants in Volta Redonda city, Rio de Janeiro, Brazil, from 2003 to 2006. Methods: Birth data was obtained from Brazilian Information System. Exposure information (O3, PM10, temperature and humidity) was provided by Governmental Air Quality Monitoring System. Linear and Logistic models, adjusted for sex, type of pregnancy, prenatal care, place of birth, maternal age, parity, education, congenital anomalies and weather variables were employed. Results: Low birth weight (LBW) represented 9.1% of all newborns (13,660). For an interquartile range increase in PM10 it was found OR2 ndTrimester = 1.06 (95%CI 1.02 - 1.10), OR3 rdTrimester = 1.06 (95%CI 1.02 - 1.10) and, in O3 it was found OR2 ndTrimester = 1.03 (95%CI 1.01 - 1.04), OR3 rdTrimester = 1.03 (95%CI 1.02 - 1.04). The dose-response relationship and a reduction in birth weight of 31.11 g (95%CI -56.64 - -5.58) was observed in the third trimester of pregnancy due to an interquartile increase of O3. Conclusion: This study suggests that exposures to PM10 and O3, even being below the Brazilian air quality standards, contribute to risks of low birth weight.
- Effects of air pollution caused by sugarcane burning in Western Sao Paulo on the cardiovascular system(2017) PESTANA, Paula Roberta da Silva; BRAGA, Alfesio Luis Ferreira; RAMOS, Ercy Mara Cipulo; OLIVEIRA, Ariadna Ferraz de; OSADNIK, Christian Robert; FERREIRA, Aline Duarte; RAMOS, DioneiOBJECTIVE: To evaluate the effects of acute exposure to air pollutants (NO2 and PM10) on hospitalization of adults and older people with cardiovascular diseases in Western Sao Paulo. METHODS: Daily cardiovascular- related hospitalization data (CID10 - 100 to 199) were acquired by the Department of Informatics of the Brazilian Unified Health System (DATASUS) from January 2009 to December 2012. Daily levels of NO2 and PM10 and weather data were obtained from Companhia Ambiental do Estado de Sao Paulo (CETESB - Sao Paulo State Environmental Agency). To estimate the effects of air pollutants exposure on hospital admissions, generalized linear Poisson regression models were used. RESULTS: During the study period, 6,363 hospitalizations were analysed. On the day of NO2 exposure, an increase of 1.12% (95% CI 0.05- 2.20) was observed in the interquartile range along with an increase in hospital admissions. For PM10, a pattern of similar effect was observed; however, results were not statistically significant. CONCLUSIONS: Even though with values within established limits, NO2 is an important short- term risk factor for cardiovascular morbidity.
- 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.
article 32 Citação(ões) na Scopus Air pollution and pediatric hospital admissions due to respiratory diseases in Cubatao, Sao Paulo State, Brazil, from 1997 to 2004(2011) JASINSKI, Renata; PEREIRA, Luiz Alberto Amador; BRAGA, Alfesio Luis FerreiraThe aim of this study was to evaluate the effects of air pollutants and their lag structures in relation to respiratory morbidity among children and adolescents in the city of Cubatao, Sao Paulo State, Brazil, from 1997 to 2004. An ecological time-series study was performed, analyzing respiratory hospital admissions of children and adolescents in National Health System hospitals in Cubatao. Generalized linear Poisson regression models were used to control for seasonality, temperature, humidity, and short-term trends. PM(10) and ozone were significantly associated with respiratory hospital admissions. Among children, inter-quartile range increases in the PM(10) 7-day moving average (56.5 mu g/m(3)) and in the ozone 5-day moving average (46.7 mu g/m(3)) led to increases of 9.6% (95%CI: 3.0%-16.1%) and 2.4% (95%CI: 0.1%-4.7%) in respiratory hospital admissions, respectively. Efforts to reduce air pollutants need to be adopted to minimize the adverse effects on children and adolescents in Cubatao.- Effects of ambient levels of traffic-derived air pollution on the ocular surface: Analysis of symptoms, conjunctival goblet cell count and mucin 5AC gene expression(2014) TORRICELLI, Andre Augusto Miranda; MATSUDA, Monique; NOVAES, Priscila; BRAGA, Alfesio Luiz Ferreira; SALDIVA, Paulo Hilario Nascimento; ALVES, Milton Ruiz; MONTEIRO, Mario Luiz RibeiroPurpose: To quantify ocular symptoms, goblet cells (GC) and mucin 5AC (MUC5AC) gene expression on the conjunctiva of healthy subjects exposed to ambient levels of traffic-derived air pollution and to estimate its correlation with NO2 and particulate matter smaller than 2.5 mu m (PM2.5) levels. Methods: Twenty-one taxi drivers or traffic controllers were assessed with the Ocular Surface Disease Index (OSDI) questionnaire and conjunctival impression cytology. MUC5AC mRNA levels were determined based on the cytology of the right eye, and GC density was assessed based on the cytology of the left eye. Mean individual levels of 24-h NO2 and PM2.5 exposure were assessed the day before examination. Possible associations between NO2 or PM2.5 levels, OSDI scores, GC densities and MUC5AC mRNA levels were verified. Results: The subjects were exposed to mean PM2.5 levels of 35 +/- 12 mu g/m(3) and mean NO2 levels of 189 +/- 47 mu g/m(3). OSDI scores were low (7.4 +/- 8) and GC densities were 521 +/- 257 and 782 +/- 322 cell/mm(2) on the bulbar and tarsal conjunctivas, respectively. The mean GC-derived MUC5AC mRNA expression was 14 +/- 7 fM/mu g of total RNA. A significant and positive correlation was observed between MUC5AC mRNA levels and tarsal GC density (p=0.018). A trend toward association between PM2.5 levels and tarsal GC cell density (p=0.052) was found. Conclusion: Exposure to ambient levels of air pollution impacts conjunctival GC density. An increase in MUC5AC mRNA levels may be part of an adaptive ocular surface response to long-term exposure to air pollution.
- 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.
- Evaluation of peak expiratory flow in adolescents and its association with inhalable particulate in a Brazilian medium-sized city(2018) MISSAGIA, Suelem; AMARAL, Camila Alves Silva do; JESUS, Alessandra Santos de; ARBEX, Marcos Abdo; SANTOS, Ubiratan de Paula; ANDRÉ, Carmem Diva Saldiva de; ANDRÉ, Paulo Afonso de; SALDIVA, Paulo Hilário do Nascimento; MARTINS, Lourdes Conceição; BRAGA, Alfésio Luís Ferreira; PEREIRA, Luiz Alberto AmadorABSTRACT: Introduction: High particulate matter (PM10) concentrations are associated with increased incidence of respiratory symptoms and decreased lung function. This study evaluates the air pollution effects in children’s and adolescents’ lung function using peak expiratory flow (PEF) measurements over a given period, in an area exposed to industrial emissions. Methodology: This was a panel study. The effects of air pollution on respiratory symptoms and PEF were investigated in 117 children and adolescents from three public schools in areas of exposure to air pollution from a mining company in a Brazilian medium-sized city, from 2008 to 2009. The average daily PM10, temperature and humidity were recorded by the monitoring network in the region. Association between daily records of PEF and PM10 was assessed in mixed-effect regression models, controlling for temperature, humidity, and body mass index. Results: About 60,000 PEF measurements were performed. Increases of 14µg/m3 in PM10 were associated with decreased PEF in the morning (-1.04%, 95%CI -1.32; -0.77) and evening (-1.2%, 95%CI -1.49, -0.92). Discussion: We found a significant negative association between particulate matter and peak expiratory flow rate in this population, and these remained significant even after adjusted for temperature, humidity, body mass index, coughing, wheezing and coryza. Conclusion: Adverse effects were found and it suggests an association between increase in PM10 and reduced lung function.
- Avaliação da qualidade de vida relacionada à saúde de cortadores de cana-de-açúcar nos períodos de entressafra e safra(2012) CARVALHO JUNIOR, Luiz Carlos Soares de; RAMOS, Ercy Mara Cipulo; TOLEDO, Alessandra Choqueta de; CECCATO, Aline Duarte Ferreira; MACCHIONE, Mariangela; BRAGA, Alfesio Luis Ferreira; RAMOS, DioneiOBJECTIVE: To assess health-related quality of life in sugarcane cutters. METHODS: Longitudinal study conducted in a sugar and ethanol plant located in the western region of the State of Sao Paulo (Southeastern Brazil) from April (pre-harvest) to October (harvest) 2010. A total of 44 sugarcane cutters, smokers and non-smokers, was evaluated in three periods: pre-harvest, at the end of the third month during harvest and at the end of harvest. Health-related quality of life was assessed by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Analysis of variance for repeated measures and the Friedman test were performed to compare quality of life among the periods. To identify the frequency of workers whose score increased in the harvest periods compared to pre-harvest (positive responders), the Goodman test was used, considering the qualitative variables of the SF-36 domains. RESULTS: At the end of pre-harvest, 23% workers drop out of work; 27% were smokers. There was a significant decrease in the vitality domain at the end of harvest compared to pre-harvest. The dropouts presented higher score in the social aspect domain compared to the group that remained working. There was no difference in health-related quality of life between smokers and non-smokers. However, there was a higher percentage of positive responders among non-smokers in the physical, social and emotional domains in the third month of harvest and in the general health status and social domains at the end of harvest, compared to smokers. CONCLUSIONS: Health-related quality of life in sugarcane cutters was reduced after the harvest period in the vitality domain. The individuals who remained working during harvest are those with lower scores for social aspects, which demonstrates the need to promote health assistance policies for this specific population, particularly during sugar harvest.
- Exposure to fine particles increases blood pressure of hypertensive outdoor workers: A panel study(2019) SANTOS, Ubiratan Paula; BRAGA, Alfesio Luis Ferreira; GARCIA, Maria Lucia Bueno; PEREIRA, Luiz Alberto Amador; LIN, Chin An; CHIARELLI, Paulo S.; ANDRE, Carmen Diva Saldiva de; ANDRE, Paulo Afonso de; SINGER, Julio M.; SALDIVA, Paulo Hilario NascimentoBackground: Hypertension and air pollution are two important risk factors for cardiovascular morbidity and mortality. Although several studies suggest that air pollution has a significant impact on blood pressure, studies on long-term effects are sparse and still controversial. Objective: To evaluate the effects of exposure of outdoor workers to different levels of traffic-generated PM2.5 on blood pressure. Design: This is an observational panel study. Participants: 88 non-smoking workers exposed to different concentrations of air pollution were evaluated weekly along four successive weeks. Measurements: In each week, personal monitoring of 24-h PM2.5 concentration and 24-h ambulatory blood pressure were measured. The association between blood pressure variables and PM2.5, adjusted for age, body mass index, time in job, daily work hours, diabetes, hypertension and cholesterol was assessed by means of multiple linear regression models fitted by least squares. Results: Exposure to PM2.5 (ranging from 8.5 to 89.7 mu g/m(3)) is significantly and consistently associated with an increase in average blood pressure. An elevation of 10 mu g/m(3) in the concentration of PM2.5 is associated with increments of 3.9 mm Hg (CI 95% = [1.5; 6.3]) in average systolic 24-h blood pressure for hypertensive and/or diabetic workers. Conclusion: Exposure to fine particles, predominantly from vehicular traffic, is associated with elevated blood pressure in hypertensive and/or diabetic workers.
- The effect of air pollution on pneumonia-related emergency department visits in a region of extensive sugar cane plantations: a 30-month time-series study(2014) ARBEX, Marcos Abdo; PEREIRA, Luiz Alberto Amador; CARVALHO-OLIVEIRA, Regiane; SALDIVA, Paulo Hilario do Nascimento; BRAGA, Alfesio Luis FerreiraBackground In Brazil, many cities are surrounded by sugar cane plantations, and when these plantations are burnt prior to harvesting, millions of people are exposed to the smoke from these fires from May to November every year. Methods A daily time-series regression analysis was conducted in a city located in the sugar cane plantation region of Sao Paulo State, Brazil, between 1 February 2005 and 31 July 2007. The percentage increase in the number of pneumonia-related emergency department visits (PEDV) associated with a 10 mu g/m(3) increase in the total suspended particles (TSP) concentration was measured, including any effects that were delayed for up to 6 days. Results A total of 1505 PEDV (a median of two events per day) were analysed. During the burning period, there was an acute effect that began on the day of exposure and remained for 2 days. An increase of 6% (95% CI 2.4 to 9.9) in PEDV was observed for the 2 days following the TSP increase. This pattern and the size of the effect were similar to those observed for the whole period and also during the non-burning period. Conclusions Increases in TSP concentrations were found to be associated with increased PEDV in a region affected by air pollution from sugar cane burning. This finding reinforces the need for polices and efforts to ban sugar cane burning prior to harvesting.