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Meta-Analysis ; Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 μg/m3 PM10 increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 μg/m3 NO2 increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects. ; INSEF was developed as part of the Predefined project financed under the Public Health Initiatives Program, ''Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation", with a 1.500.000V Grant from Iceland, Liechtenstein and Norway from EEA Grants and the Portuguese Government. The present study was also funded by the Portuguese Foundation for Science and Technology (FCT) (PhD Scholarship Reference: SFRH/ BD/129426/2017). ; info:eu-repo/semantics/publishedVersion

Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 μg/m3 PM10 increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 μg/m3 NO2 increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects. ; Highlights: Ambient air pollution (AAP) is recognized as a risk factor for cardiovascular diseases; First systematic review and meta-analysis on the association between ambient air pollutants exposure and lipid profile; Some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased Triglycerides levels; More studies are needed to clarify the association between ambient air pollutants exposure and lipid profile. ; The authors are grateful to all the professionals and participants involved in the INSEF. INSEF was developed as part of the Predefined project financed under the Public Health Initiatives Program, ''Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation", with a 1.500.000V Grant from Iceland, Liechtenstein and Norway from EEA Grants and the Portuguese Government. The present study was also funded by the Portuguese Foundation for Science and Technology (FCT) (PhD Scholarship Reference: SFRH/BD/129426/2017). ; info:eu-repo/semantics/publishedVersion

Introduction: Health surveys constitute a relevant information source to access the population's health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey. ; Introdução: Os inquéritos de saúde constituem uma importante fonte de informação para conhecer o estado de saúde da população. Visto que os erros associados aos inquéritos podem afetar significativamente as estimativas, invalidando as suas conclusões, é crucial monitorizar o progresso do trabalho de campo. Este estudo teve como objetivo descrever a monitorização do trabalho de campo realizado durante o primeiro Inquérito Nacional de Saúde com Exame Físico (INSEF) referente a desvios ao protocolo e principais indicadores de desempenho (KPI). Métodos: Dados resultantes da observação dos entrevistadores e do controlo estatístico de qualidade de alguns dos KPI foram utilizados para monitorizar as quatro componentes do inquérito (recrutamento, exame físico; colheita de sangue e questionário de saúde), durante a implementação do trabalho de campo. Os KPI selecionados incluíram a taxa de resposta, distribuição do tempo médio de realização dos procedimentos, proporção do último dígito para medidas específicas, proporção de amostras de sangue hemolisadas e dos valores omissos. Resultados: A observação dos entrevistadores permitiu identificar e corrigir atempadamente desvios ao protocolo. Após a implementação de medidas corretivas, com base na monitorização dos KPI, a taxa de participação aumentou 2,5 vezes e foi observada uma redução de 4,4 vezes na não adesão aos procedimentos padronizados para a medição da pressão arterial. Após o estudo piloto, a proporção de medições com o dígito terminal de 0 ou 5 diminuiu para 19,6% e 16,5%, respectivamente. A proporção de amostras hemolisadas foi inferior a 2,5%. A proporção dos valores omissos foi minimizada comunicando-os imediatamente ao entrevistador, que poderia recontactar o participante e completar a informação. Discussão/Conclusão: Embora a maioria dos desvios ao protocolo tenha ocorrido durante as primeiras semanas do trabalho de campo, os resultados mostram a importância da sua monitorização continua nos inquéritos de saúde de forma a garantir a qualidade dos dados recolhidos. ; INSEF was developed as part of the predefined project of the Public Health Initiatives Program, "Improvement of Epidemiological Health Information to Support Public Health Decision and Management in Portugal. Towards Reduced Inequalities, Improved Health, and Bilateral Cooperation," that benefited from a EUR 1,500,000 grant from Iceland, Liechtenstein and Norway through the EEA Grants and the Portuguese government. ; info:eu-repo/semantics/publishedVersion

<b><i>Background:</i></b> The genetic inter-individual variability of drug response can lead to therapeutic failure or adverse drug reactions (ADRs). The aims of this study were to assess the pharmacogenetic profile of a South Portuguese population according to established dosing guidelines for commonly prescribed drugs and to compare it with that of previously genotyped populations. <b><i>Methods:</i></b> A cross-sectional study was developed in the context of the Portuguese Component of the European Health Examination Survey (EHES). A total of 47 pharmacogenetically relevant variants in 23 different genes were genotyped in 208 participants. Allelic and genotypic frequencies were calculated, and the pharmacogenetic profile of the participants was defined. A comparative analysis was conducted through electronic database search. Pairwise<i> Fst</i> calculations were performed to assess the genetic distance between populations. <b><i>Results:</i></b> We found a significant small differentiation between the Portuguese regional populations regarding <i>CYP2C9 </i>rs1057910<i>, CYP2D6 </i>rs3892097<i>, MTHFR </i>rs1801133 and <i>F5 </i>rs6025. When consid-ering 4 HapMap populations, <i>ADH1B</i> rs2066702,<i> ADH1B</i> rs1229984,<i> NAT2</i> rs1799931 and <i>VKORC1</i> rs9923231 displayed a significant population differentiation. We found that 18.9% of the participants are intermediate or poor metabolizers for at least 3 drugs simultaneously and that 84.6% of the participants have at least one therapeutic failure or ADR risk allele for the considered drugs. <b><i>Conclusions:</i></b> There is a high prevalence of risk alleles associated with an altered drug metabolism regarding drugs largely used by the South Portuguese population. This knowledge contributes to the prediction of their clinical efficacy and/or toxicity, optimizing therapeutic response while improving cost-effectiveness.