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Guerreiro T, Forjaz G, Antunes L, Bastos J, Mayer A, Aguiar P, Araújo A, Nunes C. Lung cancer survival and sex-specific patterns in Portugal: A population-based analysis. Pulmonology 2023; 29 Suppl 4:S70-S79. [PMID: 34642125 DOI: 10.1016/j.pulmoe.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/10/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION In Portugal, lung cancer (LC) is the first cause of cancer-related death and of death and disability combined. This study aims to analyze the overall survival (OS) and relative survival (RS) of patients diagnosed with LC in 2009-2011 by socio-demographic and tumor characteristics, and analyze sex-specific patterns. METHODS We estimated 5-year OS using the Kaplan-Meier method and 5-year net survival through the RS framework. Cox regression modeling was used to determine the hazard ratio (HR) of death associated with each independent variable. FINDINGS For the 11,523 cases analyzed, median 5-year OS was 264 days (95% confidence interval [CI]: 254.8-273.2), the cumulative OS was 13.6% and RS was 15.1%. Males had a lower median survival (237 days; 95% CI: 228.2-245.7) compared to females (416 days; 95% CI: 384.4-447.6) (p < 0.0001) and lower 5-year RS proportions (12.1% vs. 24.9%). RS progressively decreased with age (41.7% for age-group <40 to 7.2% for ≥80) and stage (66.6% for stage I to 2.4% for stage IV). As predictors of decreased survival, we identified male gender, increasing age >50, histologic types (squamous cell carcinoma, non-small cell lung cancer not otherwise specified, other unspecified and small cell lung cancer), and increasing stage. Compared to women, the risk of death in men was 37.7% higher (HR = 1.386; 95% CI: 1.295-1.484). CONCLUSIONS The differences between OS and RS were small, reflecting the high lethality of LC. Male gender and older age are factors related to poor prognosis. Histology also plays a role in survival prognosis and varies with gender, but the factor related to the worst survival is stage. Although the study reflects data from a decade ago, and major changes occurred in diagnosis, staging and treatment, particularly for advanced disease, as LC mortality is strongly correlated with late stage diagnosis, all efforts should be made to secure early diagnosis and improve survival prospects.
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Affiliation(s)
- T Guerreiro
- NOVA National School of Public Health, NOVA University of Lisbon, Portugal.
| | - G Forjaz
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA; Azores Oncological Centre, Azores, Portugal
| | - L Antunes
- Cancer Epidemiology Group, IPO Porto Research (CI-IPOP), Portuguese Institute of Oncology Francisco Gentil, Porto, Portugal
| | - J Bastos
- Portuguese Institute of Oncology Francisco Gentil, Coimbra, Portugal
| | - A Mayer
- Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal
| | - P Aguiar
- NOVA National School of Public Health, NOVA University of Lisbon, Portugal; Public Health Research Center, NOVA University of Lisbon, Portugal
| | - A Araújo
- University Hospital Center of Porto, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - C Nunes
- NOVA National School of Public Health, NOVA University of Lisbon, Portugal; Public Health Research Center, NOVA University of Lisbon, Portugal
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Marques J, Rocha JV, Soares P, Leite A, Duarte R, Nunes C. The effect of TB patient delay on loss to follow-up in Portugal. Int J Tuberc Lung Dis 2023; 27:537-542. [PMID: 37353867 DOI: 10.5588/ijtld.22.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND: Early identification of TB cases, followed by treatment to completion, are essential for controlling and preventing the disease. Previous studies have found some factors associated with both loss to follow-up (LTFU) and patient delay. We aim to build a causal model to investigate the association between TB patient delay and LTFU.METHODS: Pulmonary TB cases were identified using the national surveillance system in Portugal between 2008 and 2017. A directed acyclic graph was used to identify the minimal set of variables to adjust for when studying the association between delay (exposure) and LTFU (outcome). Crude and adjusted hazard were estimated using Cox regression.RESULTS: Nearly 4% of the patients did not follow up treatment. There was no association between patient delay and LTFU, even after adjustment with the minimal set of covariates. Factors associated with a higher risk of LTFU were being younger, being unemployed, living in urban areas, having HIV and the abuse of alcohol and drugs.CONCLUSION: Patient delay was not associated with LTFU, while social conditions were. Future research should investigate the underlying reasons why patients discontinue TB treatment and use these findings to develop targeted interventions that can support patients in completing their treatment regimen.
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Affiliation(s)
- J Marques
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J V Rocha
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Leite
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal, Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - R Duarte
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal, Unidade de Investigação Clínica da ARS Norte, Porto, Portugal, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal, Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - C Nunes
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
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Grounds GS, Dent H, Nunes C, Dhar V. Tubeless field anaesthesia for surgical removal of an aspirated endoscopy capsule. Anaesth Rep 2023; 11:e12242. [PMID: 37588044 PMCID: PMC10425334 DOI: 10.1002/anr3.12242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
Capsule endoscopy is a safe, minimally invasive procedure used to investigate gastrointestinal bleeding of unknown origin that persists or recurs after a negative initial endoscopy. The most common adverse effects of capsule endoscopy include abdominal pain, nausea and vomiting. Capsule pulmonary aspiration, although a rare complication, has been reported in the literature. Most reported cases resolve without further medical intervention. In these cases, the capsule is either expelled by coughing, or it re-enters the oropharynx and is then swallowed. In a small number of cases, the capsule remains in the lung, unable to be expectorated. This requires prompt diagnosis and emergency bronchoscopic removal under general anaesthesia. Due to the smooth, rounded surfaces of the capsule, it may be difficult to grasp, and consequently extraction may be technically challenging. The existing literature contains limited documentation on anaesthetic and surgical approaches for managing an aspirated endoscopy capsule. In this case report, we present the management of an aspirated endoscopy capsule in a district general hospital, in which thoracic surgery was not available. Local resources were used to manage this potentially life-threatening complication without patient transfer. In our case, we provided a tubeless field to optimise surgical access. This facilitated the successful surgical extraction of the endoscopy capsule from the left main bronchus.
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Affiliation(s)
- G. S. Grounds
- Department of AnaesthesiaKent and Canterbury HospitalCanterburyKentUK
| | - H. Dent
- Department of AnaesthesiaKent and Canterbury HospitalCanterburyKentUK
| | - C. Nunes
- Department of GastroenterologyKent and Canterbury HospitalCanterburyKentUK
| | - V. Dhar
- Department of Ear, Nose and Throat SurgeryWilliam Harvey HospitalAshfordKentUK
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Alves J, Nunes C. Absence among National Health Service workers during the COVID-19 pandemic in Portugal. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
By March 2020, the first Covid-19 cases were detected in Portugal. While the National Health Service (NHS) faced an increased demand for health care, anecdotal evidence showed that the NHS absenteeism rose. This might be explained by outbreaks in healthcare units, COVID-19 infection due to close contact with patients, self-isolation and quarantines, and family challenges originated by lockdowns. The present work aimed to quantify the absenteeism among NHS workers during the COVID-19 pandemic in Portugal.
Methods
This study used data for the number of NHS workers and absence days (2015-2021), from the Portuguese NHS Transparency Portal and the Strategy and Planning Office. Absenteeism was compared, before and after the pandemic onset, in absolute terms, and as absence rates (number of absent days as a percentage of potential workforce days). Additionally, we performed an interrupted time series analysis, by fitting a Poisson regression model with level change. We controlled for data seasonality using Fourier terms (pairs of sine and cosine functions).
Results
From 2015 until March 2020, the average monthly absence rate was of 12.2, rising to 14.4 in the remaining period. This represented an increase of 18% in the absence rate. The interrupted time series showed an increase of 10.8% in the NHS absenteeism after the pandemic onset [Relative risk =1.10; 95% confidence interval (CI) 1.10-1.11; p < 0.01]. When accounting for seasonality in the data, the model showed an increase of 11.0% in the NHS absenteeism [Relative risk =1.11; 95% CI 1.01-1.22; p < 0.05].
Conclusions
These results highlight the excess of absence days among the NHS workers during the COVID-19 pandemic. In future healthcare crises, health professionals should be protected, by assuring a safe workplace and making protective equipment available. Only then will be possible to reduce constraints in healthcare assistance, guarantee the adequate response, and contain the absence costs.
Key messages
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Affiliation(s)
- J Alves
- Public Health Research Centre, NOVA National School of Public Health , Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA National School of Public Health , Lisbon, Portugal
| | - C Nunes
- Public Health Research Centre, NOVA National School of Public Health , Lisbon, Portugal
- Directorate-General of Health , Lisbon, Portugal
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Soares P, Aguiar A, Leite A, Duarte R, Nunes C. Ecological factors associated with areas of high tuberculosis diagnosis delay. Public Health 2022; 208:32-39. [DOI: 10.1016/j.puhe.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/04/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
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de Noronha N, Moniz M, Gama A, Laires PA, Goes AR, Pedro AR, Dias S, Soares P, Nunes C. Non-adherence to COVID-19 lockdown: who are they? A cross-sectional study in Portugal. Public Health 2022; 211:5-13. [PMID: 35988506 PMCID: PMC9271418 DOI: 10.1016/j.puhe.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022]
Abstract
Objectives The SARS-CoV-2 virus has spread worldwide, leading governments to implement mitigation measures. Understanding the reluctance to adhere to non-pharmacological interventions might help promote adherence to these measures. This study aimed to identify factors associated with non-adherence to the first lockdown in Portugal. Study design Cross-sectional study. Methods This study used data from a Portuguese community-based survey entitled ‘COVID-19 Barometer: Social Opinion’. Data were collected on risk perception, health status and social experiences using a snowball sampling technique. The event of interest corresponded to participants who reported not staying home during the lockdown period, serving as a proxy for non-adherence to lockdown. Logistic regression was used to identify factors associated with non-adherence to the first lockdown. Results Responses from 133,601 individual questionnaires that were completed during the first week of the first lockdown in 2020 were analysed. A minority of participants (5.6%) reported non-adherence to lockdown (i.e. leaving home for reasons other than essential situations). Working in the workplace was the factor with the strongest association of non-adherence to the lockdown. Several other factors were also associated with non-adherence to the first lockdown; namely, being a man, being a student, having a low level of education, having a low income, living alone or with a high-infection-risk professional (e.g. doctor, nurse, pharmaceutical, health technician, firefighter, police officer, military, essential services worker), perceiving the risk of getting COVID-19 to be high, not having social support in case of infection, feeling agitated, sad or anxious every day, and considering the preventive measures to be unimportant or inadequate. Conclusions Non-adherence to lockdown was associated with socio-economic, trust and perception factors. Future research should investigate the mechanisms underlying these associations to help identify the population groups who are most at risk of non-adherence.
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Affiliation(s)
- N de Noronha
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal.
| | - M Moniz
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - P A Laires
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A R Goes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A R Pedro
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - P Soares
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
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Magalhães R, Proenca MP, Araújo JP, Nunes C, Pereira AM, Sousa CT. Fabrication of FePt nanowires through pulsed electrodeposition into nanoporous alumina templates. Appl Nanosci 2022. [DOI: 10.1007/s13204-022-02454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cardoso T, Rodrigues PP, Nunes C, Almeida M, Cancela J, Rosa F, Rocha-Pereira N, Ferreira I, Seabra-Pereira F, Vaz P, Carneiro L, Andrade C, Davis J, Marçal A, Friedman ND. Prospective international validation of the predisposition, infection, response and organ dysfunction (PIRO) clinical staging system among intensive care and general ward patients. Ann Intensive Care 2021; 11:180. [PMID: 34950977 PMCID: PMC8702585 DOI: 10.1186/s13613-021-00966-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important. Methods Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included. Results There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10 ± 3 vs 8 ± 4, p < 0.001). The observed mortality was 3%, 15%, 24% and 34% in stage I, II, III and IV, respectively, which was within the predicted intervals of the original model, except for stage IV patients that presented a lower mortality. The hospital survival rate was 84%. The application of the PIRO staging system to the validation cohort resulted in a positive predictive value of 97% for stage I, 91% for stage II, 85% for stage III and 66% for stage IV. The area under the receiver operating characteristics curve (AUROC) was 0.75 for the all cohort and 0.70 if only patients with bacteremia were considered. Patients in stage III and IV who did not have antibiotic therapy administered within the desired time frame had higher mortality rate than those who have timely administration of antibiotic. Conclusions To our knowledge, this is the first external validation of this PIRO staging system and it performed well on different patient wards within the hospital and in different types of hospitals. Future studies could apply the PIRO system to decision-making about specific therapeutic interventions and enrollment in clinical trials based on disease stage. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00966-7.
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Affiliation(s)
- T Cardoso
- Intensive Care Unit (UCIP) and Hospital Infection Control Committee, Hospital de Santo António, Oporto University Hospital Center, University of Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - P P Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences & CINTESIS, Faculty of Medicine, University of Porto, Rua Dr. Plácido Costa, s/n, 4200-450, Porto, Portugal
| | - C Nunes
- Intensive Care Unit and Hospital Infection Control Committee, Hospital de Bragança, Northeastern Local Health Unit, Av. Abade Baçal, 5301-852, Bragança, Portugal
| | - M Almeida
- Neurocritical Care Unit and Hospital Infection Control Committee, Hospital de São Marcos, Sete Fontes - São Vitor, 4710-243, Braga, Portugal.,Intensive Care Unit (UCIP), Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - J Cancela
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal
| | - F Rosa
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal
| | - N Rocha-Pereira
- Infectious Diseases Department, São João Hospital Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - I Ferreira
- Internal Medicine Department, Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - F Seabra-Pereira
- Intensive Care Unit (UCIP), Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Intensive Care Unit and Internal Medicine Department, Hospital da Prelada, Rua de Sarmento de Beires, 4250-449, Porto, Portugal
| | - P Vaz
- Internal Medicine Department and Hospital Infection Control Committee, Hospital de Bragança, Northeastern Local Health Unit, Av. Abade Baçal, 5301-852, Bragança, Portugal
| | - L Carneiro
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal
| | - C Andrade
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal.,Internal Medicine Department, Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - J Davis
- Department of Renal Medicine, Barwon Health, Geelong, VIC, 3220, Australia
| | - A Marçal
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal.,Internal Medicine Department, Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - N D Friedman
- Department of Infectious Diseases, Barwon Health, Geelong, VIC, 3220, Australia
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Almeida Santos J, Soares P, Leite A, Duarte R, Nunes C. Patient and healthcare delays in critical and non-critical pulmonary tuberculosis incidence areas in Portugal: are there differences? Public Health 2021; 201:41-47. [PMID: 34742116 DOI: 10.1016/j.puhe.2021.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/08/2021] [Accepted: 09/26/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To characterize patient, healthcare, and total delay in diagnosing pulmonary tuberculosis (PTB) in critical (higher PTB incidence) and non-critical (lower PTB incidence) areas and their determinants considering clinical and sociodemographic factors. STUDY DESIGN Retrospective cohort study. METHODS Data was retrieved from the Portuguese National Tuberculosis Surveillance System (SVIG-TB). Were included in the study all active PTB patients (n = 11,762) notified between 2008 and 2017. Spatial analysis was used to define critical and non-critical areas. Kaplan-Meier estimator, logrank test, and Cox regression were conducted, stratified by area. RESULTS PTB cases in critical areas (n = 6594, 56.1%) presented longer patient median delay (41 vs 31days), shorter healthcare median delay (7 vs 10 days), and longer total median delay (63 vs 61days) t.han non-critical areas. Patient and total delay increased in both areas over time, while healthcare delay only increased in non-critical areas. Icn both areas, being from a high TB incidence country and alcohol abuse were associated with longer patient delays. Being female, older age, and oncologic diseases were associated with longer healthcare delays. Respiratory diseases were only associated with a longer healthcare delay in non-critical areas. Being female, older, and from a high TB incidence country were associated with a longer total delay in both areas. CONCLUSIONS Patient delay was significantly longer in critical areas, and healthcare delay was significantly longer in non-critical areas. Several factors associated with longer delays have been identified, most of which are shared by critical and non-critical areas. Differences in patient and healthcare delay, for example, by sex, age, or country of birth, highlight the need for targeted public health interventions to help reduce these differences.
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Affiliation(s)
- J Almeida Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; National Health Institute Dr. Ricardo Jorge, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
| | - P Soares
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
| | - A Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
| | - R Duarte
- Centro Hospitalar de Vila Nova de Gaia, Rua Conselheiro Veloso da Cruz, 4400-092 Vila Nova de Gaia, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 1169-056 Lisboa, Portugal.
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Goes AR, Soares P, Moniz M, Gama A, Pedro AR, Laires P, Dias S, Nunes C. Factors associated with motivation to avoid meeting family and friends during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574604 DOI: 10.1093/eurpub/ckab164.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The widespread adherence to behaviours that prevent the transmission of the SARS-CoV-2 virus depends on human will. There is a paucity of research on the factors that influence adherence to social distancing. Available research suggests that it varies with the specific behaviour and that reducing contact with family and friends is the hardest one. This study aims to identify factors associated with motivation to avoid meeting with family and friends during the second lockdown of the COVID-19 pandemic in Portugal. Methods We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes sociodemographics, psychosocial variables, and subjective health and wellbeing indicators from 20th February to 19th March 2021. We included 1336 participants who answered the question “To what extent is it easy for you to avoid visiting family and friends?”. Logistic regression analysis was used to identify factors associated with difficulty to avoid visiting family and friends. Results Preliminary data shows that 38.4% (513) had difficulties avoiding meeting with family and friends. Those with greater difficulty were the ones who have less education, higher negative emotionality, do not work remotely, have more difficulties to stay home and practice physical distancing and consider the Government's measures inadequate. Contrarily, those who have less difficulty avoiding visiting friends and family are older and have low risk perception of COVID-19 infection. Conclusions This study suggests higher difficulty in avoiding visiting friends and family for those whose routines demand not staying at home, with low agreement with Government measures, and struggle with higher negative emotionality, confirming the personal costs of these behaviours and the importance of habits. Older people had less difficulty, suggesting that these measures may be closer to their usual routines. Interventions should consider the specificities of social interaction. Key messages Social distancing comes at an enormous cost to people's livelihoods and it also depends on people living circumstances. Interventions to improve adherence to social distancing should consider the specificity of social interaction and the potential dissonance created by the overall routines.
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Affiliation(s)
- AR Goes
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Moniz
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Pedro
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Laires
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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Vales L, Soares P, Nunes C, Lopes S. Healthcare system delay and utilization in tuberculosis patients in Portuguese high-incidence region. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In Portugal, the Tâmega e Sousa region (TeS) has a high incidence of tuberculosis (TB) [27.4 and 43.8 per 100.000 inhabitants in sub-regions Baixo Tâmega (BxT) and Vale do Sousa Sul (VSS), 2017]. Delay in TB diagnosis leads to increased transmission, which may lead to more people infected. This study aimed to describe healthcare system delay among TB patients and healthcare utilization from symptoms onset to diagnosis in TeS.
Methods
We analysed pulmonary TB cases notified in BxT and VSS in 2014-7 in the national surveillance system (SVIG-TB). Concomitantly, we analysed healthcare utilisation from patients in a retrospective study (URBAN-TB) about TB delays in 2019-20. We characterised demographics of patients from each data source and comorbidities from SVIG-TB. We calculated median overall delay until diagnosis (days); and healthcare delay overall and by patient characteristics, for each sub-region. Delay was calculated only when relevant dates were recorded. Healthcare utilisation from symptoms onset to diagnosis was described using the frequency of each first contact provider and the average number of visits until diagnosis.
Results
Included 139 patients from BxT and 206 from VSS (83% male, 53% aged 40-59y, and 17% with silicosis). Global delays were 48 and 75 days (n = 57/132; BxT and VSS). Healthcare delays were 7 and 8 days (n = 76/180; BxT and VSS). In both ACES, healthcare delays were longer for patients aged 60-79y, with COPD and aged 0-19y. Healthcare utilisation analysis included 38 patients (89% male; 55% aged 40-59y; n = 17/21). Primary care (n = 15; 39%) and emergency department (ED) (n = 9; 24%) were frequent points of first contact. The average number of visits until diagnosis was higher for patients from ED (3.9) and lower for patients from TB specialised units (1.3).
Conclusions
Our results suggest that in TeS it is important to avoid ED as a point of first contact of TB patients and to facilitate the diagnosis in young, older and COPD patients.
Key messages
Emergency department is a relevant point of first contact and may be included in efforts to reduce tuberculosis delay. Policies to reduce tuberculosis delay may target younger, older and COPD patients.
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Affiliation(s)
- L Vales
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Lopes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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12
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Lopes S, Soares P, Gama A, Pedro AR, Moniz M, Laires P, Goes AR, Nunes C, Dias S. Factors associated with avoidance of emergency department visits in Portugal during the pandemic. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Avoiding an emergency department (ED) visit risks irreversible negative consequences for patients' health. EDs are a frequent access point to the Portuguese health system. Previous studies have shown that patients may avoid visiting ED during the pandemic. This study aims to identify factors associated with avoidance of ED visits in Portugal during the COVID-19 pandemic.
Methods
We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes healthcare utilisation, health status, and risk perception in Portugal from 11th April 2020 to 16th April 2021. We included respondents that reported having needed ED care. Data were collected on sociodemographics, health status (comorbidities, mental health), risk perception (COVID-19 and complications), level of trust in health services and self-assessment of the severity of the reason for ED visit. The outcome of interest was the decision to avoid ED care. We used logistic regression to identify factors associated with the decision to avoid ED.
Results
Preliminary data showed that 914 respondents reported needing ED care (74.8% female; mean age 43 years). From those, 224 (25%) decided to avoid ED care. ED visits avoidance was higher during lockdowns (28%). People reporting specific comorbidities (cardiac, autoimmune, respiratory) avoided ED more than those without them. Perception of no severe reason for ED visit, poor mental health, perception of higher risk of COVID-19 and complications, and low trust in health services response to the pandemic were associated with higher odds of ED visit avoidance.
Conclusions
People avoiding ED visits represented a considerable share. The decision to avoid ED visit was associated with clinical characteristics, but the perception of risk and assessment of the context and health system response also played a role in decision making.
Key messages
The effect of avoided ED visits on health should be a research and policy concern. People with certain comorbidities or perception of high risk of COVID-19 and complications may be closely monitored.
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Affiliation(s)
- S Lopes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Moniz
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Laires
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Goes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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13
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Almeida Santos J, Duarte R, Nunes C. The impact of age when screening for latent tuberculosis infection - is it a problem? Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Older population in developed countries represents a large reservoir of tuberculosis (TB) infection. Knowledge if age can contribute to false negative results in the immunological tests available for screening latent TB infections (LTBI) is critical to improve their usefulness in Public Health strategies for TB control. The aim of this study was to ascertain whether age was a risk factor for false negative (FN) results in the tuberculin skin test (TST) and in an interferon gamma release assay (IGRA).
Methods
Retrospective cohort study carried out using data from the Portuguese National Tuberculosis Surveillance system (2008-2015). Were included all active pulmonary TB cases with an IGRA (n = 597) and/or TST (n = 6185) result. TST outcomes were interpreted using a 5mm (TST-5mm) and 10mm (TST-10mm) cutoff. Logistic regression analysis crude and sex-adjusted was used to evaluate the association of age to the risk of FN results.
Results
Patients with a TST result presented a mean age of 42.7 years and patients with an IGRA result presented a median age of 45.5 years. TST-5mm, TST-10mm and IGRA had 36.5%, 43.9% and 24.5% FN results, respectively. Older patients presented a statistically significant association with the risk of FN TST results, regardless of using a 5mm [71-80years: OR 2.209; >80years: OR 2.491; p < 0.001] or 10mm [71-80years: OR 1.986; >80years: OR 2.308; p < 0.001] cut-off. Age was not a predictive factor for FN IGRA results. However, older patients presented a significant association with indeterminate IGRA results [71-80years: OR 3.808; >80years: OR 5.214; p < 0.001].
Conclusions
When using TST as part of the Public Health strategies for screening elderly patients, healthcare professionals should bear in mind that there is an increased risk of obtaining a FN result. On the other hand, age did not show an association with the occurrence of FN IGRA results, which suggests that this test could perform better when screening for LTBI in older patients.
Key messages
TST in elderly people is associated with false negative results thus, when using this test for screening for LTBI, a negative result should be interpreted with caution. IGRA was not associated with false negative results in elderly people, however indeterminate results can occur more frequently, thus performing better in this population group.
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Affiliation(s)
- J Almeida Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - R Duarte
- Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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14
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Almeida Santos J, Nunes C. Space-time analysis of pulmonary tuberculosis hospitalizations in mainland Portugal (2002-2016). Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Tuberculosis (TB) imposes a great pressure on healthcare resources, particularly in terms of hospital-based treatment and extended hospitalization. Understanding the space-time clustering of pulmonary TB (PTB) hospitalizations leads to a richer knowledge to assist decision makers in Public Health to develop strategic interventions to reduce these hospitalizations. Our objective was to identify space-time clusters of PTB hospitalizations at municipality level in mainland Portugal.
Methods
Ecologic study using data from nationwide hospitalization database of Portugal. All patients with a diagnosis of PTB (primary or secondary) and reference to place of residence were included in the study (n = 22760). Space-time analysis was used to define clusters with high rates of hospitalizations at the municipality level between 2002 and 2016.
Results
Overall hospitalization rate was 17.7/105population/year, with hospitalization rates decreasing by 64.9% during this period (2002:29.4/105; 2016:9.6/105). Space-time analysis of the overall period identified five different clusters, with the clusters in Lisboa and Porto metropolitan areas presenting the highest hospitalization rates (51.5/105 and 43.6/105population, respectively). In a more recent period (2011-2016), were identified four clusters with Lisboa metropolitan area and a northeast rural region presenting the highest hospitalization rates (27.6/105 and 46.2/105population, respectively).
Conclusions
PTB hospitalization rates in continental Portugal presented a constant decrease between 2002 and 2016. We identified a cluster of PTB hospitalizations in a rural region of northeast mainland Portugal, an area where the incidence of TB is below 20/105population. A closer look is needed to understand the reasons behind this high number of hospitalizations. Our results show that space-time analysis can be a resource to monitor the dynamic of the disease and identify possible areas needing Public Health intervention.
Key messages
Pulmonary tuberculosis hospitalizations are decreasing in mainland Portugal, with the two major urban areas (Lisboa and Porto) presenting the clusters with highest hospitalization rates. A cluster of hospitalizations for pulmonary tuberculosis was identified in a rural region in the northeast of mainland Portugal, an area with a low incidence of tuberculosis.
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Affiliation(s)
- J Almeida Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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15
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Cruz L, Silva A, Lopes J, Damas D, Lourenço J, Costa A, Silva F, Sousa J, Galego O, Nunes C, Veiga R, Machado C, Rodrigues B, Cecilia C, Almendra L, Bras A, Santo G, Machado E, Sargento-Freitas J. Early Cerebrovascular Ultrasonography as a Predictor of Hemorrhagic Transformation After Thrombectomy. J Stroke Cerebrovasc Dis 2021; 30:105922. [PMID: 34157670 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To determine the predictive value of early transcranial color-coded sonography (TCCS) for intracranial hemorrhage (ICH) in patients with large artery occlusion (LAO) stroke of carotid circulation, who were submitted to endovascular therapy (EVT) with successful reperfusion. MATERIALS AND METHODS Retrospective study evaluating a cohort of consecutive stroke patients with LAO of the carotid circulation that were recanalyzed with EVT. We measured angle-corrected peak systolic velocities, end-diastolic velocities and mean flow velocities (PSV, EDV and MFV) of the symptomatic and asymptomatic middle cerebral artery (MCA). The ratio between MFV of the symptomatic MCA and MFV of the asymptomatic MCA (MCA-Ra) was calculated. Parenchymal hematoma in the 24 hours control CT was considered as ICH. Univariate associations and multivariate analyses were used to identify early independent predictors for ICH among TCCS findings. RESULTS We included 234 patients, mean age 72.5 (SD 12.6) years, 52.1% male. The mean time between recanalization and TCCS was 12.3 hours (range 3-22). Patients who developed postinterventional ICH showed a higher MCA-Ra (1.02 ± 0.26 vs 1.16 ± 0,21, p = 0.036). In multivariate analysis, only higher MCA-Ra remained independently associated with postinterventional ICH (OR: 6.778, 95%CI: 1.152-39.892, p = 0.034). A value of MCA-Ra ≥ 1,05 was associated with ICH, showing a sensitivity of 81.3% and a specificity of 65.9%; the AUC based of the ROC analysis was 0.688 (95% CI 0.570-0.806). CONCLUSION TCCS performed within the first 24 hours after stroke onset can help to predict hemorrhagic transformation in patients with LAO.
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Affiliation(s)
- L Cruz
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - D Damas
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Lourenço
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - A Costa
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - F Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - O Galego
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Nunes
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - R Veiga
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Machado
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Rodrigues
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Cecilia
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Almendra
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Bras
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - G Santo
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Machado
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Sargento-Freitas
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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16
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Jácome C, Almeida R, Pereira AM, Araújo L, Correia MA, Pereira M, Couto M, Lopes C, Chaves Loureiro C, Catarata MJ, Santos LM, Ramos B, Mendes A, Pedro E, Cidrais Rodrigues JC, Oliveira G, Aguiar AP, Arrobas AM, Costa J, Dias J, Todo Bom A, Azevedo J, Ribeiro C, Alves M, Pinto PL, Neuparth N, Palhinha A, Marques JG, Martins P, Trincão D, Neves A, Todo Bom F, Santos MA, Branco J, Loyoza C, Costa A, Silva Neto A, Silva D, Vasconcelos MJ, Teixeira MF, Ferreira-Magalhães M, Taborda Barata L, Carvalhal C, Santos N, Sofia Pinto C, Rodrigues Alves R, Moreira AS, Morais Silva P, Fernandes R, Ferreira R, Alves C, Câmara R, Ferraz de Oliveira J, Bordalo D, Calix MJ, Marques A, Nunes C, Menezes F, Gomes R, Almeida Fonseca J. Asthma App Use and Interest Among Patients With Asthma: A Multicenter Study. J Investig Allergol Clin Immunol 2021; 30:137-140. [PMID: 32327403 DOI: 10.18176/jiaci.0456] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - R Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - A M Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - L Araújo
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - M A Correia
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - M Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - M Couto
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - C Lopes
- Unidade de Imunoalergologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - C Chaves Loureiro
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M J Catarata
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L M Santos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Ramos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - E Pedro
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - J C Cidrais Rodrigues
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - G Oliveira
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - A P Aguiar
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - A M Arrobas
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Costa
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Dias
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Azevedo
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Ribeiro
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Alves
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - P L Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - N Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - A Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - J G Marques
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - P Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - D Trincão
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - A Neves
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - F Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - M A Santos
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - J Branco
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - C Loyoza
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - A Costa
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Silva Neto
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - D Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M J Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M F Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M Ferreira-Magalhães
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - L Taborda Barata
- Serviço de Imunoalergologia, Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - C Carvalhal
- Serviço de Imunoalergologia, Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - N Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - C Sofia Pinto
- Serviço de Pneumologia, Hospital São Pedro de Vila Real, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Rodrigues Alves
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - A S Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | | | - R Fernandes
- Serviço de Pediatria, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - R Ferreira
- Serviço de Pediatria, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - C Alves
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - R Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | | | - D Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - M J Calix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - A Marques
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - C Nunes
- Imunoalergologia, Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - F Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - R Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - J Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
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17
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Eley C, Lundgren PT, Kasza G, Truninger M, Brown C, Hugues VL, Izso T, Teixeira P, Syeda R, Ferré N, Kunszabo A, Nunes C, Hayes C, Merakou K, McNulty C. Teaching young consumers in Europe: a multicentre qualitative needs assessment with educators on food hygiene and food safety. Perspect Public Health 2021; 142:175-183. [PMID: 33461394 PMCID: PMC9047106 DOI: 10.1177/1757913920972739] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Foodborne illnesses have a significant global burden and can be life-threatening, with higher risk in vulnerable groups such as children. SafeConsume is an EU-funded, transdisciplinary project aiming to improve consumers' food safety behaviour. Developing educational resources on food safety for use in schools has potential to improve teaching of our young consumers. The aim of this study was to explore school educators' attitudes, behaviours and knowledge towards food hygiene, safety and education. METHODS Focus groups and interviews in England, France, Portugal and Hungary explored educator knowledge, skills, intentions and beliefs around educating young people (11-18 years) about food safety. Data were analysed using NVivo and emerging themes were applied to the Theoretical Domains Framework. RESULTS A total of 48 educators participated. Knowledge, confidence and skills to teach food safety to young people varied depending on background and training. Educators reported they had a role to teach food safety to young people, were positive about delivering education and optimistic they could improve students' food safety behaviour. Barriers to teaching included lack of national curriculum coverage, limited time and money, and lack of facilities. Educators reported that social influences (family, celebrity chefs, public health campaigns and social media) were important opportunities to improve young peoples' awareness of food safety and consequences of foodborne illness. CONCLUSION Educator food safety expertise varied; training could help to optimise educator knowledge, confidence and skills. Ministries of Health and Education need encouragement to get food safety incorporated further into school curricula across Europe, so schools will be motivated to prioritise these topics.
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Affiliation(s)
- C Eley
- Primary Care and Interventions Unit, Public Health England, 4th Floor, Twyver House, Gloucester GL1 1DQ, UK
| | | | - G Kasza
- National Food Chain Safety Office, Budapest, Hungary
| | | | - C Brown
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK
| | | | - T Izso
- National Food Chain Safety Office, Budapest, Hungary
| | - P Teixeira
- Universidade Católica Portuguesa, Lisboa, Portugal
| | - R Syeda
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK
| | - N Ferré
- Nice University Hospital, Nice, France
| | - A Kunszabo
- National Food Chain Safety Office, Budapest, Hungary
| | - C Nunes
- University of Lisbon, Lisboa, Portugal
| | - C Hayes
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK
| | - K Merakou
- National School of Public Health, University of West Attica, Egaleo, Attica, Greece
| | - Cam McNulty
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK
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18
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Moraes S, Marinho A, Lima S, Granja A, Araújo JP, Reis S, Sousa CT, Nunes C. Targeted nanostructured lipid carriers for doxorubicin oral delivery. Int J Pharm 2021; 592:120029. [PMID: 33130218 DOI: 10.1016/j.ijpharm.2020.120029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 01/12/2023]
Abstract
The treatment with anticancer drugs remains a challenge, as available drugs still entail the risk of deleterious off-target effects. The present study describes folic acid conjugated nanostructured lipid carriers (NLCs) as an effective doxorubicin delivery approach targeted to breast cancer cells. Two distinct NLCs formulations were designed and optimized leading to an encapsulation efficiency over than 65%. Cytotoxic and targeting potential of NLCs were studied in vitro, using MDA-MB-231 cell line. Results showed an enhanced cellular uptake of conjugated NLCs. In vitro release studies, mimicking the path in the body after oral administration, show that all formulations would reach the tumor microenvironment bearing 50% of the encapsulated doxorubicin. Moreover, NLCs demonstrated storage stability at 25 °C for at least 42 days. Overall, results revealed that the developed NLCs enable the possibility of oral administration and are a promising approach for the targeted delivery of doxorubicin to breast cancer cells.
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Affiliation(s)
- S Moraes
- IFIMUP, Faculty of Sciences of Porto University, Portugal; LAQV, REQUIMTE, Faculty of Pharmacy of Porto University, Portugal
| | - A Marinho
- LAQV, REQUIMTE, Faculty of Pharmacy of Porto University, Portugal
| | - S Lima
- LAQV, REQUIMTE, Faculty of Pharmacy of Porto University, Portugal
| | - A Granja
- LAQV, REQUIMTE, Faculty of Pharmacy of Porto University, Portugal
| | - J P Araújo
- IFIMUP, Faculty of Sciences of Porto University, Portugal
| | - S Reis
- LAQV, REQUIMTE, Faculty of Pharmacy of Porto University, Portugal
| | - C T Sousa
- IFIMUP, Faculty of Sciences of Porto University, Portugal
| | - C Nunes
- LAQV, REQUIMTE, Faculty of Pharmacy of Porto University, Portugal.
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19
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Santos J, Duarte R, Nunes C. Host factors associated to false negative and indeterminate results in an interferon‐γ release assay in patients with active tuberculosis. Pulmonology 2020; 26:353-362. [DOI: 10.1016/j.pulmoe.2019.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 02/05/2023] Open
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20
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Carvalho V, Esteves P, Nunes C, Araújo D, Helsen W, Travassos B. Observe and make a call: football referee’s assessment is context sensitive. INT J PERF ANAL SPOR 2020. [DOI: 10.1080/24748668.2020.1820194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- V. Carvalho
- Department of Sport Sciences, Universidade Da Beira Interior, Covilhã, Portugal
| | - P.T. Esteves
- Polytechnic Institute of Guarda, Portugal
- CreativeLab, Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, Portugal
| | - C. Nunes
- Department of Mathematics and Center of Mathematics and Applications, Universidade Da Beira Interior, Covilhã, Portugal
| | - D. Araújo
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | - W.F. Helsen
- KU Leuven, Department of Movement Sciences, Research Group for Movement Control and Neuroplasticity, Leuven, Belgium
| | - B. Travassos
- Department of Sport Sciences, Universidade Da Beira Interior, Covilhã, Portugal
- CreativeLab, Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, Portugal
- Portugal Football School, Portuguese Football Federation, FPF, Oeiras, Portugal
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21
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Moniz M, Soares P, Nunes C. Tuberculosis among immigrants: risk factors associated with a delayed diagnosis in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A timely diagnosis is a key factor to TB control, since delayed diagnosis increases transmission, severity and mortality rates. However, immigrants have a higher risk of delay due to difficulties in the access to the healthcare services. Hence, the aim of this study is to identify risk factors associated with delays in immigrants and compare the results with the national population.
Methods
We carried out a retrospective study to analyse all pulmonary TB cases notified in Portugal having a passive case finding, between 2008 and 2017. Global delay was defined as the number of days between symptoms onset and diagnosis date and divided into patient delay (time between symptoms onset and first appointment date) and healthcare services delay (time between first appointment date and diagnosis date). A descriptive analysis was performed, and factors associated with each delay were identified using a Cox regression. Analyses were stratified by country of origin: immigrants (born outside of Portugal) and nationals (Portuguese population).
Results
Our results were consistent with previous studies and showed that the immigrant population was younger, had a higher proportion of HIV infection and had a smaller proportion of alcoholics, drug addicts, inmates, homeless and individuals living in community residencies compared to nationals. Immigrants had higher patient delay (44 vs. 36 days) compared to nationals. Different risk factors were associated with the delay in immigrants and nationals. Alcohol addiction was the only significant variable in both populations and was associated with lower delay in health services.
Conclusions
Immigrants have higher global delay, attributable to a higher patient delay. The risk factors related to TB diagnosis delay have an heterogeneous association in immigrant and nationals. Hence, tailored interventions should be implemented to decrease the delay among immigrants.
Key messages
Different risk factors were identified for the patient and healthcare services delay among immigrants and nationals, which highlight the importance to analyse each component of TB diagnosis delay. Immigrants have higher patient delay compared to nationals, hence tailored interventions should be implemented to facilitate access to healthcare services in this population.
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Affiliation(s)
- M Moniz
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
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22
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Lutfor Rahman M, Nunes C, Aguiar P. Factors related to tuberculosis delays: Evidence from nationwide retrospective study in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Globally, tuberculosis (TB) remains one of the top 10 causes of deaths and the leading cause from a single infectious agent. Delayed TB diagnosis and/or treatment may result in the transmission of bacilli, increasing infectivity, the risk of severe disease states, morbidity and mortality. It is essential to identify the factors that prolong delays in TB services so that health planners can initiate necessary measures to control TB infections.
Methods
A nationwide retrospective study was conducted from 2010 until 2013 to analyze tuberculosis delays under the setting of the Portuguese National Tuberculosis Control Programme. There were 16824 participants who were from 25 administrative districts under 7 regions and were originated from 70 countries in the world. The log-rank test, Cox's regression, and the Kaplan-Meier method have employed to analyze TB delay data.
Results
The median of patients` delay was 34 days with interquartile ranges (IQR) 50 days. Alcohol addicted people with TB infection were delayed by 40 days with 95% CI 37.73-42.28 whereas the non-addicted people took 33 days with 95% CI 32.35-33.65. The median diagnostic delay was 12 days with an IQR of 38 days. The female participants were delayed more than that of male (median delay for female 17 days with 95% CI 15.80-18.19) in TB diagnosis. Further, comorbidities e.g. lung cancer affected TB candidates were delayed more than their counterparts (median delay 37 days with 95% CI 23.29-50.70). The median of public health delays was 63 days with IQR 72 days. The females were delayed more than that of males (median delay 68 days with 95% CI 66.06-69.94). The adjusted Cox's regression identifies the features - older age, female, drug addiction, and community residence as potential factors that might affect TB delays.
Conclusions
It is essential to emphasize on the influencing dynamics - older age, female patients, HIV patients, alcohol addiction, and comorbidities to minimize TB delays.
Key messages
To minimize spreading risk of TB infections the dynamics of TB delays e.g. older age, female patients, drug, and alcohol addiction, comorbidities should be prioritized in the TB control programs. Special attention should be given to other lung diseases while diagnosing TB infections.
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Affiliation(s)
- M Lutfor Rahman
- Institute of Statistical Research & Training, University of Dhaka, Dhaka, Bangladesh
| | - C Nunes
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - P Aguiar
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
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23
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dos P, Luís S, Nunes C. Heat waves and mortality: developing a local prediction model based on two kinds of heat waves. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heat waves (HW) will tend to have a higher impact on mortality due to climate change. The aim of this study was to develop a tailored model to predict local mortality associated to HW.
Methods
In this ecological study, daily temperature and daily mortality were collected from May to October of 1980 to 2017 in Coimbra, Portugal. Two definitions of HW were used: more than two consecutive days of maximum temperature (MaxT) or minimum temperature (MinT) above percentile 95 for the periods in question. Attributable general mortalities with 13 and 30 lag days were calculated and then converted to attributable general mortality rates adjusted to the resident population. Bivariate and multivariate analyses with SPSS statistics were performed with the following independent variables for each HW: MaxT, diurnal temperature variation (DTV), mean of the mean daily temperatures, month, ageing index (AI), ordinal number of the HW for that year (ONHW), duration, overlapping of another HW and existence of a public health contingency plan.
Results
The multivariate analyses returned a R2=0,19 for the MaxT model (MaxTM) for both 13 and 30 lag days and a R2=0,51 for the MinT model (MinTM) with 13 lag days and R2=0,45 for 30 lag days. DTV was the only variable with statistical significance in the MaxTM (p < 0,023; β = 0,44 for 13 lag days and p < 0,024; β = 0,43 for 30 lag days). In the MinTM model two variables had statistical significance: AI (p < 0,008; β = 1,72 for 13 lag days and p < 0,037; β = 0,44 for 30 lag days) and ONHW (p < 0,038; β= -0,44 for 30 lag days).
Conclusions
MaxTM and MinTM had different predictability potentials with different statistical significant independent variables. This may mean HW defined by MaxT have impact in a distinct way from HW defined by MinT. Further development of these models that include acclimatization indexes and causes of mortality may help local public health services to create more efficient, selective contingency plans.
Key messages
Minimum and maximum temperature defined heat waves may impact mortality differently. Local heat wave/mortality models may contribute to more efficient, selective contingency plans than regional models.
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Affiliation(s)
| | - Santos Luís
- Public Health Unit, Pinhal Interior Norte Primary Healthcare Cluster/ARS Centro, Oliveira do Hospital, Portugal
| | - C Nunes
- Public Health Research Centre, NOVA National School of Public Health/Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
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24
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Leite A, Soares P, Santos J, Nunes C. Delays in the diagnosis of pulmonary tuberculosis in critical and non-critical areas in Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Delays in diagnosing tuberculosis lead to longer infectious periods, posing a challenge in tuberculosis control. This is particularly relevant in high incidence areas (critical). Thus, the objectives of this work were to characterize tuberculosis diagnosis delay and its components (patient delay and health delay) in incidence critical and non-critical areas in Portugal, as well as associated factors.
Methods
Notified cases of pulmonary tuberculosis diagnosed due to symptoms (passive screening) in the Portuguese Tuberculosis Surveillance System were analysed (2008-2017). Patient, health and overall delays were calculated. Factors associated with each delays' components were identified utilising Cox regression, while adjusting for sex, age and education level. Analyses were stratified by area type (critical and non-critical).
Results
Median (1st-3rd quartile - Q1-Q3) delays in patient, health and overall delay in critical areas were: 40 (Q1-Q3: 21-76), 8 (Q1-Q3:1-31), and 65 (Q1-Q3: 40-105) days, respectively; similar delays in non-critical areas were 32 (Q1-Q3:16-63); 9 (Q1-Q3: 1-34) and 58 (Q1-Q3: 35-98), respectively. More recent cases, adults younger than 65 years and alcoholic presented longer patient delays (both areas); healthcare professionals and patients with HIV infection presented shorter patient delays (only critical areas). Tuberculosis high-risk groups (males, alcohol dependency, homelessness, community residency) presented shorter health delays in both areas; drug use also presented shorter health delays but only in critical areas. Existing comorbidities was associated with longer health delays in both areas.
Conclusions
Patient delays increased between 2008 and 2017. Groups with longer/shorter delays differed between delay type and area type. Intervening in tuberculosis diagnosis delays requires different action for critical and non-critical areas, targeting health literacy from the general population and training of healthcare professionals.
Key messages
Delays in diagnosing in Portugal are mainly driven by delays in patient seeking care and are longer in areas of higher tuberculosis incidence. Intervening in tuberculosis diagnosis delays in Portugal requires different action in different areas, targeting health literacy in the general population and training of professionals.
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Affiliation(s)
- A Leite
- Public Health Research Centre, NOVA National School of Public Health, Lisbon, Portugal
- Public Health Unit, Primary Healthcare Cluster, Amadora, Portugal
| | - P Soares
- Public Health Research Centre, NOVA National School of Public Health, Lisbon, Portugal
| | - J Santos
- Public Health Research Centre, NOVA National School of Public Health, Lisbon, Portugal
| | - C Nunes
- Public Health Research Centre, NOVA National School of Public Health, Lisbon, Portugal
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25
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Affiliation(s)
- C. Santos
- Department of Mathematics and Physical Sciences, Polytechnic Institute of Beja, Beja, Portugal
- CMA- Center of Mathematics and its Applications, Faculty of Science and Technology, New University of Lisbon, Portugal
| | - C. Nunes
- Department of Mathematics and Center of Mathematics and Applications, University of Beira Interior, Covilhã, Portugal
| | - C. Dias
- Polytechnic Institute of Portalegre, Portalegre, Portugal
- CMA- Center of Mathematics and its Applications, Faculty of Science and Technology, New University of Lisbon, Portugal
| | - J.T. Mexia
- Department of Mathematics, Faculty of Science and Technology, New University of Lisbon, Portugal
- CMA- Center of Mathematics and its Applications, Faculty of Science and Technology, New University of Lisbon, Portugal
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26
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Martins C, Vidal A, De Boevre M, De Saeger S, Nunes C, Torres D, Goios A, Lopes C, Alvito P, Assunção R. Burden of disease associated with dietary exposure to carcinogenic aflatoxins in Portugal using human biomonitoring approach. Food Res Int 2020; 134:109210. [PMID: 32517894 DOI: 10.1016/j.foodres.2020.109210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022]
Abstract
Human biomonitoring is an important tool to assess human exposure to chemicals, contributing to describe trends of exposure over time and to identify population groups that could be under risk. Aflatoxins are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In Portugal, scarce data are available regarding exposure to aflatoxins and no previous study used human biomonitoring data to comprehensively characterize the associated burden of disease. 24 h urine and first-morning urine paired samples were collected by 94 participants and were analyzed by liquid chromatography-tandem mass spectrometry for the quantitative determination of aflatoxins (B1, B2, G1, G2 and M1). Deterministic and probabilistic models were developed to assess the Portuguese exposure to aflatoxins and to estimate the health impact of this exposure, estimating the attributed Disability-Adjusted Life Years (DALYs). Aflatoxins were detected in a maximum of 13% (AFB1), 16% (AFB2), 1% (AFG1), 2% (AFG2) and 19% (AFM1) of the urine samples. Data obtained through the probabilistic approach revealed an estimated mean probable daily intake of 13.43 ng/kg body weight per day resulting in 0.13 extra cases of hepatocellular carcinoma, corresponding to mean annual DALYs of 172.8 for the Portuguese population (10291027 inhabitants). The present study generated for the first time and within a human biomonitoring study, reliable and crucial data to characterize the burden associated to the exposure to aflatoxins of the Portuguese population. The obtained results constitute an imperative support to risk managers in the establishment of preventive policy measures that contribute to ensure public health protection.
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Affiliation(s)
- C Martins
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal; NOVA National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal; Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal.
| | - A Vidal
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - M De Boevre
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - S De Saeger
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - C Nunes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal
| | - D Torres
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-091 Porto, Portugal; Faculty of Nutrition and Food Sciences, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - A Goios
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-091 Porto, Portugal; Faculty of Nutrition and Food Sciences, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - C Lopes
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-091 Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - P Alvito
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal; CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - R Assunção
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal; CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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Martins C, Assunção R, Nunes C, Torres D, Alvito P. Are Data from Mycotoxins’ Urinary Biomarkers and Food Surveys Linked? A Review Underneath Risk Assessment. Food Reviews International 2020. [DOI: 10.1080/87559129.2019.1709200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- C. Martins
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
- CISP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - R. Assunção
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | - C. Nunes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
- CISP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - D. Torres
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - P. Alvito
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
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28
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Martins C, Vidal A, De Boevre M, De Saeger S, Nunes C, Torres D, Goios A, Lopes C, Alvito P, Assunção R. Burden of disease attributable to exposure to aflatoxins in Portugal using Human biomonitoring data. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Human biomonitoring (HBM) is recognized as an important tool to assess the Human exposure to chemicals, contributing to describe trends and patterns of exposure over time and to identify population groups that could be under risk. Natural chemicals as mycotoxins, fungi metabolites that produce toxic effects in humans, are important compounds that could be found in foods usually consumed worldwide in a daily basis. Mycotoxins as aflatoxins (AFTs) are genotoxic, carcinogenic and immunosuppressive compounds. Hepatocellular carcinoma (HCC) is one of their main health toxic effects and is the third leading cause of cancer deaths worldwide. In Portugal, scarce data are available regarding exposure to AFTs and none previous study used HBM data to characterize comprehensively the burden associated to this exposure.
In the scope of the National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015-2016), 24h-urine samples from 94 participants were analyzed by liquid chromatography-mass spectrometry (LC-MS/MS) for the simultaneous determination of AFTs (B1, B2, G1, G2, M1). A model was developed to estimate the health impact of the exposure of Portuguese population to aflatoxins, estimating the number of cases of HCC and DALYs attributed to AFTs exposure.
AFTs were detected in 12.8% (AFB1), 16.0% (AFB2) and 19.1% (AFM1) of the 24h-urine samples. The estimated number of extra cases of HCC attributed to this exposure ranged from 17 to 65 cases/year; the associated DALYs for the Portuguese population ranged from 284 to 1802 years.
The present study generated, for the first time and within a HBM study, reliable data regarding the exposure of the Portuguese population to AFTs. These data were crucial to characterize the health impact associated to AFTs exposure and to support risk managers to establish preventive policy measures that contribute to ensure the public health protection.
Key messages
Portuguese population is exposed to aflatoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) to humans. Human biomonitoring studies provide realistic data on internal exposure at individual level, contributing to a more accurate estimation of the burden derived from this exposure.
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Affiliation(s)
- C Martins
- National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - A Vidal
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Portugal
| | - M De Boevre
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Portugal
| | - S De Saeger
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Portugal
| | - C Nunes
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - D Torres
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - A Goios
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - C Lopes
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - P Alvito
- National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - R Assunção
- National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
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Martins C, Vidal A, De Saeger S, Nunes C, Torres D, Goios A, Lopes C, Assunção R, Alvito P, De Boevre M. Risk assessment of Portuguese population to multiple mycotoxins: the human biomonitoring approach. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Mycotoxins constitute a relevant group of food contaminants with several associated health outcomes such as estrogenic, immunotoxic, nephrotoxic and teratogenic effects. Although scarce data are available in Portugal, human biomonitoring studies have been globally developed to assess the exposure to mycotoxins at individual level.
The present study concerned the analysis of mycotoxins in 24h urine and first-morning urine paired samples from 94 participants enrolled within the scope of the National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015-2016). Following a salt-assisted matrix extraction, urine samples were analyzed by liquid chromatography-mass spectrometry for the simultaneous determination of 37 urinary mycotoxins’ biomarkers and data obtained used to estimate the probable daily intake as well as the risk characterization applying the Hazard Quotient approach.
Results revealed the exposure of Portuguese population to zearalenone, deoxynivalenol, ochratoxin A, alternariol, citrinin and fumonisin B1 through the quantification in 24h urine and first-morning urine paired samples. Risk characterization data revealed a potential concern to some reported mycotoxins since the reference intake values were exceeded by some of the considered participants. Alternariol was identified for the first time in urine samples from a European country; however, risk characterization was not performed due to lack of reference intake value.
The present study contributed with reliable and evidence-based results, and confirmed that mycotoxins represent a burden and are part of the human exposome of the Portuguese population. Further studies are needed to shed a light on the determinants of exposure in order to contribute for the promotion of public health measures to reduce the mycotoxins’ exposure in Portugal.
Key messages
Portuguese population is exposed to mycotoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) for human health. Human biomonitoring studies provide realistic data on internal exposure at individual level, allowing a more accurate knowledge of the determinants of exposure to these contaminants.
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Affiliation(s)
- C Martins
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - A Vidal
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - S De Saeger
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - C Nunes
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - D Torres
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - A Goios
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - C Lopes
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Assunção
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - P Alvito
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - M De Boevre
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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Bhering M, Kritski A, Nunes C, Duarte R. Multidrug-resistant tuberculosis in Lisbon: unfavourable treatment and associated factors, 2000-2014. Int J Tuberc Lung Dis 2019; 23:1075-1081. [PMID: 31627772 DOI: 10.5588/ijtld.18.0596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The incidence of tuberculosis (TB) has been decreasing in Portugal. Lisbon concentrates the largest number of cases of multidrug-resistant (MDR) TB in the country. This study aims at identifying clinical and demographic factors associated with unfavourable treatment results of patients with MDR-TB in the city.METHOD: The data on 265 MDR-TB cases, notified from 2000 to 2014 in the District of Lisbon, were collected from the Tuberculosis Surveillance System. Unfavourable cases were classified as failure, loss to follow-up (LTFU) and death. Bivariate and multivariate logistic regressions were undertaken to estimate the factors associated with unfavourable outcomes, LTFU and death.RESULTS: The proportion of unfavourable outcomes was 30.5%. These were associated mostly with being male, foreign-born and resistant to kanamycin. Death was associated with being human immunodeficiency virus-positive and resistant to kanamycin. Being foreign-born had a 4.46-fold higher odds of a LTFU outcome than did being Portuguese-born. The foreign-born patients were mostly African immigrants.CONCLUSION: The main finding in this study is that foreign-born patients are associated with a higher probability of unfavourable outcomes than Portuguese-born patients. Therefore, foreign-born patients need more careful monitoring in the control of MDR-TB.
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Affiliation(s)
- M Bhering
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazilian Tuberculosis Network, Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Kritski
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazilian Tuberculosis Network, Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Nunes
- National School of Public Health at the Nova University Lisbon, Lisbon
| | - R Duarte
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Lisbon, Public Health Science and Medical Education Department, School of Medicine, University of Porto, Porto, Portugal
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31
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Martins C, Vidal A, De Boevre M, De Saeger S, Nunes C, Torres D, Goios A, Lopes C, Assunção R, Alvito P. Exposure assessment of Portuguese population to multiple mycotoxins: The human biomonitoring approach. Int J Hyg Environ Health 2019; 222:913-925. [DOI: 10.1016/j.ijheh.2019.06.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/18/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
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Ferreira AL, Nunes C, Mendes JG, Amorim P. Do we have today a reliable method to detect the moment of loss of consciousness during induction of general anaesthesia? Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:93-103. [PMID: 30077394 DOI: 10.1016/j.redar.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/03/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
This review aims to give an overview of the current state of monitoring depth of anaesthesia and detecting the moment of loss of consciousness, from the first clinical signs involved in anaesthesia to the latest technologies used in this area. Such techniques are extremely important for the development of automatic systems for anaesthesia control, including preventing intraoperative awareness episodes and overdoses. A search in the databases Pubmed and IEEE Xplore was performed using terms such anaesthetic monitoring, depth of anaesthesia, loss of consciousness, as well as anaesthesia indexes, namely BIS. Despite the several methods capable of monitoring the hypnotic state of anaesthesia, there is still no methodology to accurate detect the moment of loss of consciousness during induction of general anaesthesia.
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Affiliation(s)
- A L Ferreira
- LAETA/INEGI, Faculdade de Engenharia da Universidade do Porto, Oporto, Portugal; Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal.
| | - C Nunes
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal; Departamento de Ciências e Tecnologia, Universidade Aberta, Oporto, Portugal
| | - J G Mendes
- LAETA/INEGI, Faculdade de Engenharia da Universidade do Porto, Oporto, Portugal
| | - P Amorim
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Oporto, Portugal
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Affiliation(s)
- C Nunes
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - L Rahman
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
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Affiliation(s)
- J Santos
- National School of Public Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - R Duarte
- Faculty of Medicine of University of Porto, Centro Diagnóstico Pneumológico de Vila Nova de Gaia, Lisbon, Portugal
| | - C Nunes
- National School of Public Health, Public Health Research Center, Lisbon, Portugal
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35
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Martins C, De Boevre M, De Saeger S, Assunção R, Nunes C, Torres D, Goios A, Lopes C, Alvito P, Vidal A. Exposure of Portuguese population to mycotoxins: the contribution of human biomonitoring studies. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Martins
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Lisbon, Portugal
| | - M De Boevre
- Laboratory of Food Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - S De Saeger
- Laboratory of Food Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - R Assunção
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Lisbon, Portugal
| | - C Nunes
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - D Torres
- Faculty of Nutrition and Food Sciences, University of Porto; Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - A Goios
- Faculty of Nutrition and Food Sciences, University of Porto; Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - C Lopes
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto; Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - P Alvito
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Lisbon, Portugal
| | - A Vidal
- Laboratory of Food Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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Rocha J, Nunes C, Leonardo A, Correia MJ, Fernandes M, Paúl MC, Almeida V. Women generating narratives after an unwanted prenatal diagnosis result: randomized controlled trial. Arch Womens Ment Health 2018; 21:453-459. [PMID: 29502281 DOI: 10.1007/s00737-018-0822-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
We have defined a psychological intervention based on cognitive narrative therapy and the Ottawa decision framework to reduce adjustment problems following a termination of pregnancy (TOP) after a positive prenatal diagnosis (PND). The intervention is composed of four sessions: decision, subjectivation, metaphorization, and projecting. This study aims to assess the effectiveness of a cognitive narrative intervention to prevent depression and anxiety symptoms after TOP. The intervention was accepted by 24 participants. The outcome is compared with a control group of 67 women who also terminated a pregnancy after PND. Participants were from several Portuguese institutions; 64.4% had a genetic and 35.6% had ultrasound diagnosis; the mean age was 30.0 years and the mean gestational age was 19 weeks. There are two evaluations: a baseline at the 15th day and a sixth month follow-up after TOP, using Beck Depression Inventory, Zung Anxiety Scale, Perinatal Grief Scale, and an instrument capturing participant satisfaction. Six months after TOP, there is a lower mean of anxiety and depression (p < 0.05), between groups, with effect sizes on the follow-up of 0.54 for depression, 0.41 for anxiety, and 0.23 for perinatal grief. This intervention has very positive effects on women mental health, and we emphasize the importance of the meaning-making process in the context of terminating a wanted pregnancy.
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Affiliation(s)
- José Rocha
- IINFACTS, CESPU, Gandra, Portugal. .,Centro de Psicologia do Trauma e do Luto, Porto, Portugal.
| | - C Nunes
- IINFACTS, CESPU, Gandra, Portugal
| | | | | | | | - M C Paúl
- Universidade do Porto, Porto, Portugal
| | - V Almeida
- IINFACTS, CESPU, Gandra, Portugal.,Centro de Psicologia do Trauma e do Luto, Porto, Portugal
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Cavalcanti SMT, Nunes C, Costa Lima SA, Soares-Sobrinho JL, Reis S. Optimization of nanostructured lipid carriers for Zidovudine delivery using a microwave-assisted production method. Eur J Pharm Sci 2018; 122:22-30. [PMID: 29933076 DOI: 10.1016/j.ejps.2018.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/28/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
An adapted methodology for obtaining lipid nanoparticles that only uses the microwave reactor in the synthesis process was developed. The method has the following features: one-pot, one-step, fast, practical, economical, safe, readiness of scaling-up, lack of organic solvents and production of nanoparticles with low polydispersity index (PDI) (below 0.3). This new method was applied for the development of nanostructured lipid carriers (NLC) loaded with a hydrophilic drug, the antiretroviral agent zidovudine (AZT). The aim of the present work was to develop, evaluate and compare optimized NLC formulations produced by two different methods - hot ultrasonication and microwave-assisted method. The development and optimization of the NLC formulations were supported by a Quality by Design (QbD) approach. All formulations were physicochemically characterized by the same parameters. The optimized formulations presented a suitable profile for oral administration (particle size between 100 and 300 nm, PDI < 0.3 and negative zeta potential >-20 mV). Furthermore, the morphologies assessed by TEM showed spherical shape and confirmed the results obtained by DLS. Both AZT loaded formulations were physically stable for at least 45 days and non-toxic on Jurkat T cells. Drug release studies showed a controlled release of AZT under gastric and plasma-simulated conditions.
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Affiliation(s)
- S M T Cavalcanti
- LAQV, REQUIMTE, Department of Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Core of Medicine and Correlated Quality Control - NCQMC, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Rua Arthur de Sá, s/n, Cidade Universitária, 50, 740-521 Recife, PE, Brazil
| | - C Nunes
- LAQV, REQUIMTE, Department of Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
| | - S A Costa Lima
- LAQV, REQUIMTE, Department of Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - J L Soares-Sobrinho
- Core of Medicine and Correlated Quality Control - NCQMC, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Rua Arthur de Sá, s/n, Cidade Universitária, 50, 740-521 Recife, PE, Brazil
| | - S Reis
- LAQV, REQUIMTE, Department of Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Frade J, Nunes C, Mesquita JR, São José Nascimento M, Gonçalves G. Rubella antibodies in cord blood sera in Portugal: association with maternal age and vaccination status. Epidemiol Infect 2018; 146:600-605. [PMID: 29458448 PMCID: PMC9134545 DOI: 10.1017/s0950268818000237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 01/04/2018] [Accepted: 01/21/2018] [Indexed: 11/06/2022] Open
Abstract
This study evaluated the impact of maternal vaccination against rubella on the levels of specific rubella IgG (rIgG) in 198 newborn cord sera samples. Detailed maternal vaccination data were available. Specific rIgG was measured using a commercial enzyme immunoassay. Most mothers (78.8%) had been vaccinated against rubella at least once in their lives. In 15 (7.6%) cord sera samples, the concentration of specific rIgG was below 11 IU/ml, which was classified as seronegative. Statistical analysis using multiple logistic regression (n = 198) showed that newborns of mothers born between 1986 and 1995, and those born to unvaccinated mothers, were more likely to be seronegative (odds ratio (ORs) 5.2 and 4.9, respectively, adjusted for sex and gestational age). For vaccinated mothers (n = 156), those born between 1986 and 1995 were more likely to have seronegative newborns (OR 11.5 adjusting for sex, gestational age and time since last vaccination). Mothers of the 15 (7.6%) seronegative newborns might have been susceptible to rubella during pregnancy. Checking the vaccination status therefore recommended.
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Affiliation(s)
- J. Frade
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
- Health Research Unit of School of Health Sciences, Polytechnic Institute of Leiria, Campus 2 – Morro do Lena – Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - C. Nunes
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal
| | - J. R. Mesquita
- Agrarian Superior School, Polytechnic Institute of Viseu, Quinta da Alagoa – Estrada de Nelas, Ranhados, 3500 – 606 Viseu, Portugal
| | - M. São José Nascimento
- Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy of University of Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - G. Gonçalves
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Nunes C, Taylor BM. Modelling the time to detection of urban tuberculosis in two big cities in Portugal: a spatial survival analysis. Int J Tuberc Lung Dis 2018; 20:1219-25. [PMID: 27510249 DOI: 10.5588/ijtld.15.0822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Portuguese National Tuberculosis Control Programme. OBJECTIVE To examine delays in tuberculosis (TB) diagnosis using a spatial component in two high-incidence cities, Lisbon and Oporto, in Portugal, a low-incidence country. DESIGN A retrospective nationwide study was conducted based on official TB data between 2010 and 2013 to analyse diagnostic delays at the lowest administrative level (freguesias) using spatial survival analyses, taking into account individual level covariates. RESULTS Median diagnostic delays in Lisbon (n = 2706 cases) and Oporto (n = 1883) were respectively 62 (range 1-359, mean 81.01) and 60 days (range 1-3544, mean 79.5). In both cities, case detection rates initially rose until 50 days, then stabilised, but rose again at about 200 days. Diagnostic delay was significantly shorter among males and human immunodeficiency virus positive individuals in both cities, but was significantly longer among migrants in Lisbon. There is evidence of spatial correlation between freguesias; different spatial patterns were observed in diagnostic delays and in likelihood of case detection. CONCLUSION These results are concordant with existing literature. The two study areas present considerable spatial variations in diagnostic delay, highlighting the fact that large cities should not be treated as homogeneous entities. The potential of spatial survival methods in spatial epidemiology is highlighted.
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Affiliation(s)
- C Nunes
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - B M Taylor
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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40
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Werneck MR, Nunes C, Jerdy H, Carvalho ECQ. Loggerhead turtle, Caretta caretta (Linnaeus, 1758) (Testudines, Cheloniidae), as a new host of Monticellius indicum Mehra, 1939 (Digenea: Spirorchiidae) and associated lesiond to spirorchiid eggs. Helminthologia 2017. [DOI: 10.1515/helm-2017-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
The present note describes the occurrence of Monticellius indicum Mehra, 1939 (Digenea: Spirorchiidae) in an adult loggerhead turtle, Caretta caretta (Linnaeus, 1758), found on the coast of the state of Rio de Janeiro, Brazil. Pathological changes due to spirorchiid eggs (type 1 and 3) were found in gastrointestinal system, endocrine system, and heart. This parasite has previously been described in the green turtle, Chelonia mydas (Linnaeus, 1758), from Pakistan, Brazil and Costa Rica as well as in the hawksbill sea turtle, Eretmochelys imbricata (Linnaeus, 1766), in Brazil. This note reports the loggerhead turtle as a new host for M. indicum.
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Affiliation(s)
- M. R. Werneck
- BW Veterinary Consulting. Rua Ponciano Eugênio Duarte number 203, Centro, Ubatuba, SP, Zip code (CEP): 11680-000 , Brazil
| | - C. Nunes
- CTA Serviços em Meio Ambiente , Rua Saturnino Rangel Mauro 283, Pontal de Camburi, Vitória, Zip code (CEP): 29062-030, Espírito Santo State, Brazil
| | - H. Jerdy
- North Fluminense State University – Darcy Ribeiro (UENF) , Campos dos Goytacazes, Zip code (CEP): 28013-602, Rio de Janeiro State, Brazil
| | - E. C. Q. Carvalho
- North Fluminense State University – Darcy Ribeiro (UENF) , Campos dos Goytacazes, Zip code (CEP): 28013-602, Rio de Janeiro State, Brazil
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Guerra-Paiva S, Sousa P, Nunes C. Using ICD-9-CM to find adverse events relation with diagnosis admissions in hospitals. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - P Sousa
- National School of Public Health, Lisbon, Portugal
| | - C Nunes
- National School of Public Health, Lisbon, Portugal
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Correia I, Jesus-Ribeiro J, Batista S, Martins AI, Nunes C, Macário MC, Cunha L, Sousa L. Anti-JCV antibody serostatus and longitudinal evaluation in a Portuguese Multiple Sclerosis population. J Clin Neurosci 2017; 45:257-260. [PMID: 28844615 DOI: 10.1016/j.jocn.2017.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 06/13/2017] [Accepted: 08/06/2017] [Indexed: 11/25/2022]
Abstract
Multiple Sclerosis (MS) treatment with natalizumab is associated with Progressive Multifocal Leukoencephalopathy (PML). The risk of PML being related to the anti-JCV antibody index is well established, but there is less known about seroconversion rates in natalizumab-treated patients and longitudinal variation in the anti-JCV antibody index. Our objective was to assess anti-JCV antibody prevalence in an MS population and to evaluate the evolution of the anti-JCV antibody index in natalizumab-treated patients. To assess anti-JCV antibody prevalence, we included all patients who had the anti-JCV antibody test in our consultation, regardless of the treatment. To evaluate the evolution of the anti-JCV antibody index and seroconversion, only natalizumab-treated patients with at least two samples were selected. Demographic characteristics were evaluated. From a total of 371 patients included, 68.19% (n=253) were seropositive for anti-JCV antibodies (JCV+). There was a significant difference in anti-JCV antibody seropositivity concerning gender (male 76.27% vs. female 64.43%, p=0.023), but not age. To evaluate seroconversion, 85 patients who were initially seronegative (JCV-) were selected. The annual rate of seroconversion in the first two years was stable, but after that there was a significant increase with treatment duration (ρ=0.90, p=0.037): in the first year it was 5.88% (n=5/85); in the second, 5.71% (n=4/70); in the third, 6.82% (n=3/44); in the fourth, 10.34% (n=3/29); and in the fifth, 15.0% (n=3/20). The mean index variability was higher in patients who experienced seroconversion (1.16±0.97), followed by JCV+ patients (0.44±0.48), compared to JCV- patients (0.08±0.05). In conclusion, anti-JCV antibody prevalence in our population is comparable to other reported cohorts. The seroconversion rate increased with treatment duration. We found a high fluctuation in the antibody index in JCV+ patients.
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Affiliation(s)
- I Correia
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal.
| | - J Jesus-Ribeiro
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - S Batista
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - A I Martins
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - C Nunes
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - M C Macário
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - L Cunha
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - L Sousa
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal
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Correia I, Batista S, Galego O, Marques IB, Jesus-Ribeiro J, Martins AI, Nunes C, Macário MC, Cunha L, Sousa L. Long-term effectiveness and safety of natalizumab in a Portuguese population. Int Immunopharmacol 2017; 46:105-111. [DOI: 10.1016/j.intimp.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 11/27/2022]
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Nunes C, Silva C, Correia-Branco A, Martel F. Lack of effect of the procarcinogenic 17β-estradiol on nutrient uptake by the MCF-7 breast cancer cell line. Biomed Pharmacother 2017; 90:287-294. [PMID: 28365520 DOI: 10.1016/j.biopha.2017.03.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/26/2022] Open
Abstract
Breast cancer is one of the most frequent cancers in the population, especially in older women. Estrogen is known to be a key hormone in the development and progression of mammary carcinogenesis. In this study, we investigated if the procarcinogenic effect of 17β-estradiol (E2) in breast cancer MCF-7 cells is dependent on changes in glucose or folic acid cellular uptake. The effect of E2 on uptake of 3H-deoxy-d-glucose, 3H-folic acid, cell proliferation (3-thymidine incorporation assay), culture growth (sulforhodamine B assay), viability (lactate dehydrogenase activity assay), lactate production and migration capacity (injury assay) was evaluated. E2 (48h; 100nM) increased culture growth (16%), proliferation rate (24%), cellular viability (36%) and lactate production (38%). In contrast, E2 did not significantly affect the migration capacity of MCF-7 cells. The pro-proliferative, but not the cytoprotective effect of E2 was found to be ERβ-dependent. The polyphenols rutin and caffeic acid were not able to counteract the effect of E2 upon cell proliferation and viability. Uptake of 3H-deoxy-d-glucose was not affected by E2, either in the absence or presence of GLUT inhibitors (cytochalasin B plus phloridzin). Moreover, E2 did not change GLUT1 mRNA levels. Finally, 3H-folic acid uptake was also not affected by E2, both in the absence and presence of the RFC1 inhibitor, methotrexate. The pro-proliferative and cytoprotective effects of E2 are not dependent neither of stimulation of glucose cellular uptake (both GLUT and non-GLUT-mediated) nor of stimulation of folic acid uptake (both RFC1-and non-RFC1-mediated).
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Affiliation(s)
- C Nunes
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Institute for Research and Innovation in Health Sciences (I3S), University of Porto, Porto, Portugal
| | - C Silva
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Institute for Research and Innovation in Health Sciences (I3S), University of Porto, Porto, Portugal
| | - A Correia-Branco
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Institute for Research and Innovation in Health Sciences (I3S), University of Porto, Porto, Portugal
| | - F Martel
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Institute for Research and Innovation in Health Sciences (I3S), University of Porto, Porto, Portugal.
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Sousa P, Uva A, Serranheira F, Uva M, Nunes C. Patient and hospital characteristics that influence incidence of adverse events in acute hospitals. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Santana P, Loureiro A, Almendra R, Nunes C. Determinants of mental health in Lisbon Region in a period of economic crisis. A multi-level study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Almendra R, Nunes C, Santana P. Mental health during an economic crisis in a metropolitan area of Portugal: individual and environmental factors. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw165.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Braido F, Scichilone N, Lavorini F, Usmani OS, Dubuske L, Boulet LP, Mosges R, Nunes C, Sánchez-Borges M, Ansotegui IJ, Ebisawa M, Levi-Schaffer F, Rosenwasser LJ, Bousquet J, Zuberbier T, Canonica GW. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA 2LEN). Asthma Res Pract 2016; 2:12. [PMID: 27965780 PMCID: PMC5142416 DOI: 10.1186/s40733-016-0027-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy. This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.
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Affiliation(s)
- F Braido
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - N Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - O S Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - L Dubuske
- Immunology Research Institute of New England, Harvard, USA
| | - L P Boulet
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - R Mosges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - C Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - M Sánchez-Borges
- Centro Medico Docente La Trinidad, Caracas, Venezuela ; Clinica El Avila, Caracas, Venezuela
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Carretera Leioa-Inbe, Erandio, Bilbao, Spain
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - F Levi-Schaffer
- Department of Pharmacology and Experimental Therapeutics, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - L J Rosenwasser
- University of Missouri - Kansas City, School of Medicine, Kansas City, Missouri USA
| | - J Bousquet
- Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France
| | - T Zuberbier
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Walter Canonica
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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Braido F, Scichilone N, Lavorini F, Usmani OS, Dubuske L, Boulet LP, Mosges R, Nunes C, Sanchez-Borges M, Ansotegui IJ, Ebisawa M, Levi-Schaffer F, Rosenwasser LJ, Bousquet J, Zuberbier T, Canonica GW, Cruz A, Yanez A, Yorgancioglu A, Deleanu D, Rodrigo G, Berstein J, Ohta K, Vichyanond P, Pawankar R, Gonzalez-Diaz SN, Nakajima S, Slavyanskaya T, Fink-Wagner A, Loyola CB, Ryan D, Passalacqua G, Celedon J, Ivancevich JC, Dobashi K, Zernotti M, Akdis M, Benjaponpitak S, Bonini S, Burks W, Caraballo L, El-Sayed ZA, Fineman S, Greenberger P, Hossny E, Ortega-Martell JA, Saito H, Tang M, Zhang L. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA 2LEN). World Allergy Organ J 2016; 9:37. [PMID: 27800118 PMCID: PMC5084415 DOI: 10.1186/s40413-016-0123-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/24/2016] [Indexed: 12/21/2022] Open
Abstract
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy. This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.
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Affiliation(s)
- F Braido
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - N Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - O S Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - L Dubuske
- Immunology Research Institute of New England, Harvard, USA
| | - L P Boulet
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - R Mosges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - C Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - M Sanchez-Borges
- Centro Medico Docente La Trinidad, Caracas, Venezuela ; Clinica El Avila, Caracas, Venezuela
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Carretera Leioa-Inbe, Erandio, Bilbao Spain
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - F Levi-Schaffer
- Department of Pharmacology and Experimental Therapeutics, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - L J Rosenwasser
- University of Missouri - Kansas City, School of Medicine, Kansas City, Missouri USA
| | - J Bousquet
- Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France
| | - T Zuberbier
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Walter Canonica
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Cruz
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Yanez
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Yorgancioglu
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - D Deleanu
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - G Rodrigo
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J Berstein
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - K Ohta
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - P Vichyanond
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - R Pawankar
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S N Gonzalez-Diaz
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Nakajima
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - T Slavyanskaya
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Fink-Wagner
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - C Baez Loyola
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - D Ryan
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J Celedon
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J C Ivancevich
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - K Dobashi
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - M Zernotti
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - M Akdis
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Benjaponpitak
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Bonini
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - W Burks
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - L Caraballo
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Z Awad El-Sayed
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Fineman
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - P Greenberger
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - E Hossny
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - J A Ortega-Martell
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - H Saito
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - M Tang
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - L Zhang
- Allergy and Respiratory Diseases Department DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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Nunes C, Usall J, Manso T, Torres R, Olmo M, García JM. Effect of High Temperature Treatments on Growth of Penicillium spp. and their Development on ‘Valencia’ Oranges. FOOD SCI TECHNOL INT 2016. [DOI: 10.1177/1082013207075601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of time (up to 24h) and temperature (40 to 55°C) has been evaluated on in vitro growth of Penicillium digitatum and Penicillium italicum on potato dextrose agar plates or on ‘Valencia’ oranges ( Citrus sinensis), previously inoculated with those pathogens. The effect of treatment on the fruit quality parameters has also been evaluated. In vitro, at 40 and 45°C, an exposure of 24h was required to inhibit subsequent mycelial growth of both pathogens during incubation for 1 week at 25°C. However, at 50 and 55°C, only 18 or 9h (6h for P. digitatum), respectively, were needed to achieve the same effect on both pathogens. Inoculated fruit was exposed for 18h at 40°C then stored for 5 days at 5°C plus 7 days at 20°C, and the experiment was repeated at three locations and over two fruit seasons. This curing regime controlled both pathogens effectively. Concerning quality changes, after cold storage (5°C), treated fruits showed a significant reduction in acid content and a slight delay on skin yellowing, on softening, and on weight losses, compared to the control fruits. These results suggest that the curing treatment could be a non-chemical alternative to the postharvest fungicides now used to control citrus green and blue moulds.
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Affiliation(s)
- C. Nunes
- Centro de Desenvolvimento de Ciências e Técnicas de Produção Vegetal (CDCTPV), Universidade do Algarve, Campus de Gambelas, 8000-139 Faro, Algarve, Portugal
| | - J. Usall
- Area Postcolit, IRTA, Centre UdL-IRTA. Av Rovira Roure 198, 25191 Lleida, Spain
| | - T. Manso
- Centro de Desenvolvimento de Ciências e Técnicas de Produção Vegetal (CDCTPV), Universidade do Algarve, Campus de Gambelas, 8000-139 Faro, Algarve, Portugal
| | - R. Torres
- Area Postcolit, IRTA, Centre UdL-IRTA. Av Rovira Roure 198, 25191 Lleida, Spain
| | | | - J. M. García
- Instituto de la Grasa, CSIC, Av Padre García Tejero 4, 41012 Seville, Spain
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