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NOVEL CHROMOSOMAL ALTERATION DER(2)T(2;15)(Q37;Q21) IN A PEDIATRIC PATIENT WITH MYELODYSPLASTIC SYNDROME: MOLECULAR CYTOGENETIC STUDIES. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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CYTOGENETIC BICLONAL ABNORMALITIES IN PEDIATRIC AND ADULT PATIENTS WITH MYELODYSPLASTIC SYNDROME: CLINICAL IMPLICATIONS. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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UM MODELO DE EVOLUÇÃO PARA SÍNDROME MIELODISPLÁSICA PEDIÁTRICA: SOB UM OLHAR CITOGENÉTICO E EPIGENÉTICO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Decentralization Process in Portugal: impact in the health care system. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Problem
Different countries have incorporated models of decentralization in their health reforms to achieve efficiency, by increasing the training of local governments, responsibility and gains in areas such as quality, costs and equity. In Portugal, the 21st government program established the autonomy of local authorities and the democratic decentralization of public administration. Accordingly, a decentralization law was approved and local governments have now a crucial role on health policies.
Description of the Problem
For this framework, a situational diagnosis and an intersectoral approach to policies are needed. This is an observational, analytical and cross-sectional study developed at council level in two Portuguese municipalities. This study aims to: Adjust responses to health needs at the local level; Set priorities by taking into account installed capacity and responses to populations; Promote the articulation between entities; Strengthen the focus on health promotion and healthy lifestyles; Strengthen health interventions in educational communities; Promote the creation of programs at local level, in conjunction with the national level, to reduce inequalities.
Results
The preliminary results in health, social and economic indicators show that this framework, while taking in consideration population characteristics, allows the development of local strategies regarding health services coverage, health services type and medication. At council level, the preliminary results also show a lack of data on healthy lifestyles and social indicators.
Lessons
The implementation of a decentralization process involves a broad range of requirements such as a situational diagnosis, strategies development and a periodic update of quality life and health indicators. Those are needed to assess council level priorities, which allow the development of public policies and interventions, in line with population characteristics, to tackle health inequalities and inequities.
Key messages
Performance improvement of health system is linked to the implementation of local citizen centred policies. These are actions which promote quality of life through health-friendly ecosystems. The local health intervention has contributed to promote inequalities reduction, increasing equity and dynamize new frameworks of organization with individual and community participation.
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Local Tuberculosis Georeference: a tool to define BCG vaccination in high-incidence area in Portugal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Tuberculosis (TB) incidence in Portugal is < 20/100000 people, with high-incidence municipalities in urban areas such as Amadora. In 2016, the national vaccination programme moved the BCG vaccine from universal to restricted risk groups. Amadora, due to the higher-incidence area, maintained a universal vaccination policy. Recently, it was hypothesized that vaccination could be applied to specific parishes even in high incidence counties.
Description
We aimed to identify specific geographic areas with higher risk of TB to help redefine the local BCG vaccination policy. We proposed to georeference active TB cases between 2015 and 2017, in Amadora, to then assess the incidence per parish and statistical section. We also aimed at identifying geo-clusters and density of cases.
Methods
(1) notified TB cases from 1 January of 2015 to 31 December 2017 were extracted from TB surveillance system; (2) cases of latent TB infection (LTBI), cases out of Amadora’s bounds and without national ID were excluded; (3) ArcGis®Online and associated maps were used to provide populational estimates; (4) cumulative incidence was calculated per year and averaged for the 3-year period; (5) Clusters were determined using distance and simple density of cases was calculated using Kernel algorithm.
Results
Considering the 6 parishes of Amadora, the 3-year cumulative incidence varied from 19.58 to 38.3 per 100000 hab. The highest incidence was found on the parish with the best socio-economic profile. 14 geo-clusters were mapped; 3 matched known deprived neighborhoods. Overall density was higher in these neighborhoods.
Lessons
With this approach we found that deprived neighborhoods had higher levels of case density, but 3-year cumulative incidence was higher on the parish considered to have low occurrence of TB. As such, and due to the intense population flows in Amadora, the local public health unit recommended the persistence of BCG vaccination to all residents of the municipality.
Key messages
Georeferecing supported our recommendation to mantain a universal BCG vaccination policy. Georeferencing associated to surveillance systems is highly useful to ensure evidence based public health practices, even at the local level.
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Benefits from a tabletop exercise in a Heat-Health Action Plan in Amadora, Portugal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Issue
National guidelines for Heat-Health Action Plans (HHAP) in Portugal exist since 2004. These guidelines are further developed and implemented at Local Public Health Units (LPHU) together with local partners. Tabletop exercises are a useful tool to improve preparedness. Despite the long experience with HHAP there has not been any tabletop exercise in Amadora.
Description
Amadora’s LPHU organized a tabletop exercise with local partners to improve HHAP preparedness (12th July 2018). It included: LPHU, city hall, civil protection services, local social services, primary healthcare services, local public hospital, and firefighters. The exercise hypothesized a scenario of an unprecedented increase of temperature for an extended period of time, activating the highest level of warning (red) and action in the HHAP.
Results
During the exercise several issues were identified. Some partners were not clear about the pathway established for red warnings and partners were not aware of relevant HHAP activities. Also, from the 8 sites listed as climate shelters, only 2 were deemed as adequate for using in this scenario, even though they have been listed for several HHAP. Due to the exercise, it was possible to conduct an inspection of said shelters, which hadn’t took place yet due to the lack of resources. It was possible to find out that only one shelter was fit for purpose. Additional private facilities were identified as desirable shelter locations during the exercise. A few weeks later, a red warning was issued and clarification arising from the tabletop exercise was useful to properly implement measures.
Lessons
Despite the perceived frequent and good communication among partners of the HHAP, several issues - mainly regarding the adequacy of shelters - were identified with a tabletop exercise. It also improved preparedness for the following HHAP warning. As such, tabletop exercises should be promoted within HHAP.
Key messages
Despite developing heat-health action plans for several years, with the involvement of community partners, unidentified constraints existed in Amadora, Portugal. Tabletop exercises should be used more frequently, as we were able to identify and solve constraints within our heat-health action plan using one.
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Costs of a School-based intervention in Amadora – are we applying our money wisely? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Evaluating interventions in schools - growing experience in Public Health Unit in Amadora, Portugal. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tuberculosis surveillance systems in Portugal: an evaluation in a high incidence area (2016 to 2017). Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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