Browsing by Author "Gomes, Manuel Carmo"
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- Determinants of maternal health care and birth outcome in the Dande Health and Demographic Surveillance System area, AngolaPublication . Rosário, Edite Vila Nova; Gomes, Manuel Carmo; Brito, Miguel; Costa, DiogoMaternal health care improvement and reduction of maternal and child mortality are priorities of the global health agenda. In Angola, maternal mortality remains high and the risk of pregnancy-related death was 1 in 32 during 2015. This study aims to identify demographic and social factors influencing antenatal care and health facility delivery among women in Dande and to understand their impact on birth outcomes. Methods: This study is based on community-based longitudinal data collected by the Dande Health and Demographic Surveillance System between 2009 and 2015. Data on pregnancy outcomes (10,289 outcomes of 8,066 women) were collected for all reported pregnancies, including sociodemographic information, health services utilization and women's reproductive history. Logistic regression was used to investigate the determinants of birth outcomes, antenatal care attendance, and institutionalized delivery. Findings: Of the 10,289 pregnancy outcomes, 98.5% resulted in live births, 96.8% attended antenatal care, and 82.5% had four or more visits. Yet, 50.7% of the women delivered outside a health facility. Antenatal care attendance was a determinant of birth outcomes (stillbirth: unadjusted OR = 0.34 95% CI = 0.16-0.70; abortion: OR = 0.07 95% CI = 0.04-0.12). Older women, with lower education, living at a greater distance of a health facility and in rural areas, were less likely to use maternal health care. Having had previous pregnancies, namely resulting in live births, also decreased the likelihood of health care utilization by pregnant women. Conclusions: The study identifies relevant social determinants for the utilization of antenatal care, place of delivery and their impact on birth outcome, thereby providing insight on how best to address inequities in health care utilization.
- Exposição ocupacional a formaldeído: avaliação da exposição e efeitos genotóxicosPublication . Ladeira, Carina; Viegas, Susana; Carolino, Elisabete; Gomes, Mário; Prista, João; Gomes, Manuel Carmo; Brito, MiguelO formaldeído (FA) foi classificado, em 2004, pela International Agency for Cancer Research como agente cancerígeno. Este agente químico ocupa a 25ª posição em toda a produção química dos Estados Unidos da América, com mais de 5 milhões de toneladas produzidas por ano. Devido à sua importância económica e uso diversificado, muitos indivíduos estão expostos profissionalmente a FA. Com o estudo desenvolvido pretendeu‑se avaliar a exposição a FA em dois contextos ocupacionais distintos – na produção de FA e resinas e em laboratórios de anatomia patológica (AP) e relacionar com eventuais efeitos para a saúde, comparando a frequência de micronúcleos (MN) em linfócitos do sangue periférico e em células esfoliadas da mucosa bucal dos trabalhadores expostos a FA com indivíduos não expostos (controlos). Como amostra foram estudados 80 trabalhadores ocupacionalmente expostos a FA: 30 trabalhadores da fábrica de produção de FA e resinas e 50 trabalhadores de 10 laboratórios de AP. Foi constituído um grupo controlo de 85 indivíduos com atividades profissionais que não envolviam a exposição a formaldeído ou qualquer outro agente químico com propriedades genotóxicas. Aplicaram‑se duas metodologias distintas de avaliação ambiental do FA com o objetivo de conhecer a exposição profissional. Compararam‑se os resultados obtidos com os valores limite para a exposição média ponderada (TLV‑TWA=0,75 ppm) e para a concentração máxima (VLE‑CM=0,3 ppm). A totalidade dos laboratórios apresentou resultados superiores ao valor de referência existente para a concentração máxima. Nenhum dos resultados obtidos para a exposição média ponderada foi superior ao valor de referência. O exame macroscópico obteve os valores das concentrações máximas mais elevadas em 90% dos laboratórios. Os valores de MN foram mais elevados nos indivíduos expostos a FA comparativamente com os controlos. No caso dos MN nos linfócitos, a média foi de 3,96 nos expostos e de 0,81 nos não expostos. Os MN nas células esfoliadas da boca apresentaram uma média de 0,96 nos expostos e de 0,16 nos controlos. Os resultados obtidos nesta acção de biomonitorização podem revelar‑se particularmente úteis para as organizações responsáveis em definir os níveis aceitáveis para a exposição humana a FA. ABSTRACT: Since 2004, formaldehyde (FA) has been classified by the International Agency for Cancer Research as a carcinogen. The FA ranks 25th in the overall United States chemical production, with more than 5 million tons produced each year. Due to its economic importance and varied use, many individuals are exposed to FA at their occupational settings. This study aimed to assess the exposure to FA in two occupational settings – FA production factory and pathology anatomy (PA) laboratories – and relate it to possible health effects by comparing frequency of micronuclei (MN) in peripheral blood lymphocytes and exfoliated cells from the oral mucosa of workers exposed to FA with individuals not exposed to this agent (controls). This study was performed in 80 workers occupationally exposed to FA: 30 workers of the FA factory and 50 workers in 10 PA laboratories. The control group comprised 85 subjects without exposure. We have applied two different methodologies for environmental monitoring of FA. The results were compared with the reference to the exposure weighted average (TLV‑TWA = 0.75 ppm) and ceiling concentration (VLE‑MC = 0.3 ppm). All laboratories had results higher than the reference value to CM (1.41 ppm). None of the results obtained for the TWA exposure (0.16 ppm) were higher than the reference value. Macroscopic examination obtained the highest values of CM in 90% of laboratories. MN values were higher in individuals exposed to FA as compared to controls. As for MN in lymphocytes, the average was 3.96 in exposed compared with 0.81 in the unexposed. The MN in exfoliated cells of the buccal mucosa had an average of 0.96 in exposed, compared with 0.16 in controls. The results of this biomonitoring can be particularly useful to organizations responsible for defining acceptable levels for human exposure to FA.
- Genotoxicity biomarkers: application in histopathology laboratoriesPublication . Ladeira, Carina; Viegas, Susana; Carolino, Elisabete; Gomes, Manuel Carmo; Brito, MiguelMost cancers results from man-made and natural environmental exposures (such as tobacco smoke; chemical pollutants in air, water, food, drugs; radon; and infectious agents) acting in concert with both genetic and acquired characteristics. It has been estimated that without these environmental factors, cancer incidence would be dramatically reduced, by as much as 80%-90%. The modulation of environmental factors by host susceptibility was rarely evaluated. However, within the past few years, the interaction between environmental factors and host susceptibility factors has become a very active area of research. Molecular biology as a tool for use in epidemiological studies has significant potential in strengthening the identification of cancers associated with environmental exposures related to lifestyle, occupation, or ambient pollution. In molecular epidemiology, laboratory methods are employed to document the molecular basis and preclinical effects of environmental carcinogenesis. Molecular epidemiology has become a major field of research and considerable progress has been made in validation and application of biomarkers and its greatest contribution has been the insights provided into interindividual variation in human cancer risk and the complex interactions between environmental factors and host susceptibility factors, both inherited and acquired, in the multistage process of carcinogenesis.