ISBE - Artigos em Revistas Internacionais
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- Uptake of uranium by lettuce (Lactuca sativa L.) in natural uranium contaminated soils in order to assess chemical risk for consumersPublication . Neves, O.; Abreu, M.M.; Vicente, E.M.Uranium mining activity in Cunha Baixa (Portugal) village has left a legacy of polluted soils and irrigation water. A controlled field experiment was conducted with lettuce (Lactuca sativa L.) in an agricultural area nearby the abandoned mine in order to evaluate uranium uptake and distribution in roots and leaves as well as ascertain levels of uranium intake by the local inhabitants from plant consuming. Two soils with different average uranium content (38 and 106 mg/kg) were irrigated with non-contaminated and uranium contaminated water (<20 and >100 μg/l). A non-contaminated soil irrigated with local tap water (<1 μg/l uranium) was also used as a control. Uranium in lettuce tissues was positively correlated with soil uranium content, but non-significant differences were obtained from contaminated soils irrigated with different water quality. Uranium in plants (dry weight) growing in contaminated soils ranged from 0.95 to 6 mg/kg in roots and 0.32 to 2.6 mg/kg in leaves. Lettuce bioconcentration is more related to available uranium species in water than to its uranium concentration. Translocated uranium to lettuce leaves corresponds to 30% of the uranium uptake whatever the soil or irrigation water quality. A maximum uranium daily intake of 0.06 to 0.12 μg/kg bodyweight day was estimated for an adult assuming 30 to 60 g/day of lettuce is consumed. Although this value accounts for only 10% to 20% of the recommended Tolerable Daily Intake for ingested uranium, it still provides an additional source of the element in the local inhabitants’ diet
- Sugarcane (Saccharum sp. Hybrid) propagated in headspace renovating systems shows autotrophic characteristics and develops improved anti-oxidative responsePublication . Aragón, Carlos; Carvalho, Luísa A.; González, Justo; Escalona, Maritza; Amâncio, SaraPrevious results have shown that sugarcane plantlets micropropagated in Temporary Immersion Bioreactors (TIB) demonstrated a better morphology and physiological behaviour when compared to plantlets propagated in Gelled Medium (GM). The present work focuses on the onset of oxidative stress symptoms at transfer to ex vitro and during acclimatization. The specific ROS being produced were identified and tissue-located by infiltrating leaves with specific O2 −.and H2O2 staining dyes, respectively NBT and DAB. TIB plantlets showed trichomes stained with NBT and DAB, their density decreasing with time. Stomata were coloured with NBT and DAB in GM and, at the end of acclimatization, plantlets from both systems presented the lowest level of staining of both stomata and trichomes. The response of the anti-oxidative system was also analysed through in vitro and in gel enzyme activities and transcription levels of genes for key response enzymes. At the end of the in vitro phase, GM plantlets showed higher activities of APX and MDHAR, while CAT, GR, GT and DHAR activities increased in TIB. At the end of acclimatization SOD and CAT increased mainly in TIB, while GM induced the increase of APX. The immunobloting of peroxiredoxins showed that Prxs were expressed at higher levels in TIB plantlets, some showing polymerization. The transcription of genes coding for key response enzymes was strongly upregulated in GM plantlets. In conclusion and comparing with GM, TIB produced plantlets closer to autotrophy and with improved mobilization of the anti-oxidative response.
- An overview of systematic reviews of economic evaluations of pharmacy-based public health interventions : addressing methodological challengesPublication . Costa, Suzete; Cary, Maria; Helling, Dennis K.; Pereira, João; Mateus, CéuBackground: Pharmacy interventions are a subset of public health interventions and its research is usually performed within the scope of a trial. The economic evaluation of pharmacy interventions requires certain considerations which have some similarities to those of public health interventions and to economic evaluations alongside trials. The objective of this research is to perform an overview of systematic reviews of economic evaluations of pharmacy services and triangulate results with recommendations for economic evaluations of both public health interventions and alongside trials. Methods:(1) Exploratory review of recommendations on the economic evaluation of public health interventions, (2)exploratory review of recommendations for conducting economic evaluations alongside trials, (3) overview of systematic reviews of economic evaluations of pharmacy interventions (protocol registered with PROSPERO 2016 outlining information sources, inclusion criteria, appraisal of reviews and synthesis methods). Results: Fourteen systematic reviews containing 75 index publications were included. Reviews reported favourable economic findings for 71% of studies with full economic evaluations. The types of economic analysis are diverse. Two critical quality domains are absent from most reviews. Key findings include the following: certain types of risk of bias, wider scope of study designs, and most economic quality criteria met but some issues unresolved or unclear. Triangulation revealed additional gaps. Limitations include choice of critical quality domains and potential biases in the overview process. Conclusions: Economic evaluations of pharmacy-based public health interventions seem to follow most economic quality criteria, but there are still some issues in certain key areas to improve. These findings may assist in improving the design of pilot trials of economic evaluations in pharmacy, leading to robust evidence for payers. Based on the findings, we propose a methodological approach for the economic evaluation of pharmacy-based public health interventions. Systematic review registration: PROSPERO CRD42016032768
- Costs and consequences of the Portuguese needle-exchange program in community pharmaciesPublication . Borges, Margarida; Gouveia, Miguel; Fiorentino, Francesca; Jesus, Gonçalo; Cary, Maria; Guerreiro, José Pedro; Costa, Suzete; Carneiro, António VazBackground: Needle-exchange programs (NEPs) reduce infections in people who inject drugs. This study assesses the impact community pharmacies have had in the Needle-Exchange Program in Portugal since 2015. Methods: Health gains were measured by the number of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections averted, which were estimated, in each scenario, based on a standard model in the literature, calibrated to national data. The costs per infection were taken from national literature; costs of manufacturing, logistics and incineration of injection materials were also considered. The results were presented as net costs (i.e., incremental costs of the program with community pharmacies less the costs of additional infections avoided). Results: Considering a 5-year horizon, the Needle Exchange Program with community pharmacies would account for a 6.8% (n = 25) and a 6.5% reduction (n = 22) of HCV and HIV infections, respectively. The present value of net savings generated by the participation of community pharmacies in the program was estimated at €2,073,347. The average discounted net benefit per syringe exchanged is €3.01, already taking into account a payment to community pharmacies per needle exchanged. Interpretation: We estimate that the participation of community pharmacies in the Needle Exchange Program will lead to a reduction of HIV and HCV infections and will generate over €2 million in savings for the health system. Conclusions: The intervention is estimated to generate better health outcomes at lower costs, contributing to improving the efficiency of the public health system in Portugal.
- The burden of atherosclerosis in PortugalPublication . Costa, João; Alarcão, Joana; Araujo, Francisco; Ascenção, Raquel; Caldeira, Daniel; Fiorentino, Francesca; Gil, Victor; Gouveia, Miguel; Lourenço, Francisco; Mello e Silva, Alberto; Sampaio, Filipa; Carneiro, António Vaz; Borges, MargaridaAims: This paper sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. Methods and results: The burden of atherosclerosis was measured in disability-adjusted life years (DALY) following the latest 2010 Global Burden of Disease (GBD) methodology. DALYs were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischemic heart disease (IHD) (including acute myocardial infarction (AMI), stable angina, and ischemic heart failure (IHF)), ischemic cerebrovascular disease (ICVD) and peripheral arterial disease (PAD). YLL were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. YLD corresponded to the product of the number of prevalent cases by an average disability weight (DW) for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. DW were sourced from the published literature. In 2016, 15,123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. DALYs totaled 260,943, 75% due to premature death (196,438 YLL) and 25% due to disability (64,505 YLD). Conclusion: Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.
- The role of health preconditions on COVID-19 deaths in Portugal : evidence from surveillance data of the first 20293 infection casesPublication . Nogueira, Paulo Jorge; Nobre, Miguel de Araújo; Costa, Andreia; Ribeiro, Ruy M.; Furtado, Cristina; Bacelar-Nicolau, Leonor; Camarinha, Catarina; Luís, Márcia; Abrantes, Ricardo Silva Macedo; Carneiro, António VazBackground: It is essential to study the effect of potential co-factors on the risk of death in patients infected by COVID-19. The identification of risk factors is important to allow more efficient public health and health services strategic interventions with a significant impact on deaths by COVID-19. This study aimed to identify factors associated with COVID-19 deaths in Portugal. Methods: A national dataset with the first 20,293 patients infected with COVID-19 between 1 January and 21 April 2020 was analyzed. The primary outcome measure was mortality by COVID-19, measured (registered and confirmed) by Medical Doctors serving as health delegates on the daily death registry. A logistic regression model using a generalized linear model was used for estimating Odds Ratio (OR) with 95% confidence intervals (95% CI) for each potential risk indicator. Results: A total of 502 infected patients died of COVID-19. The risk factors for increased odds of death by COVID-19 were: sex (male: OR = 1.47, ref = female), age ((56–60) years, OR = 6.01; (61–65) years, OR = 10.5; (66–70) years, OR = 20.4; (71–75) years, OR = 34; (76–80) years, OR = 50.9; (81–85) years, OR = 70.7; (86–90) years, OR = 83.2; (91–95) years, OR = 91.8; (96–104) years, OR = 140.2, ref = (0–55)), Cardiac disease (OR = 2.86), Kidney disorder (OR = 2.95), and Neuromuscular disorder (OR = 1.58), while condition (None (absence of precondition); OR = 0.49) was associated with a reduced chance of dying after adjusting for other variables of interest. Conclusions: Besides age and sex, preconditions justify the risk difference in mortality by COVID-19.
- An overview of Portugal's educational challenges and responses to the global pandemic of COVID-19Publication . Costa, Filipa A.; Auxtero, Maria Deolinda; Martins, Ana Paula; Caramona, Maria MargaridaThe current pandemic of SARS-CoV-2 came un-expectantly and required unprecedented ability to adapt and quickly put in place the most appropriate response measures to limit the spread of COVID-19 disease, while minimising disruption to society’s essential activities. Some sectors were more capable of adapting and reacting than others. Higher education was one of the sectors where the academic capacity (FIP Development Goal 1) demonstrated was phenomenal, partially attributable to the ability to create partnerships between academia and practice. This editorial provides a description of the major changes put in place in Portugal to ensure the education and training of future graduates in Pharmaceutical Sciences was maintained with the same quality. It also discusses some of the potentially less beneficial long-term impacts of these adaptions to the teaching and assessment methods for the competencies of the workforce of tomorrow.
- Patient access to gene therapy medicinal products : a comprehensive reviewPublication . Carvalho, Marta; Sepodes, Bruno; Martins, Ana PaulaBackground Gene therapies have the potential to be a curative approach to a large number of genetic diseases. However, granting of a positive marketing authorisation does not equal patient access to therapy. Objectives The purpose of this paper is to identify a full set of hurdles potentially preventing patient access to gene therapies based on the available literature. Methods A review of the literature using systematic approach in two distinct databases was performed by identifying relevant, peer-reviewed publications, between 2012 and 2018. Results Seven major topics were identified as potential patient access hurdles, namely affordability, assessment of value, development of therapy, ethical/social factors, evidence generation, operational implementation and regulatory hurdles. From these, 25 additional subthemes were further identified. The most frequently mentioned obstacle in the literature is related to the affordability aspect especially focusing on high cost of therapy (84%) and therapy payment/reimbursement (51%). Importantly, the evidence generation focusing on limited trial outcomes (81%) seems as a strong obstacle in patient access to these therapies. Conclusions A growing number of gene therapies are expected to be developed and made available to patients and healthcare professionals. Improvement of patient access to gene therapies can only be achieved by understanding all hurdles, in a complete and integrated fashion, so that strategies are timely established to ensure gene therapies’ benefits are provided to patients and to the society.
- Health literacy and health behavior among women in Ghazni, AfghanistanPublication . Harsch, Stefanie; Jawid, Asadullah; Jawid, Ebrahim; Saboga-Nunes, Luis; Sørensen, Kristine; Sahrai, Diana; Bittlingmayer, Uwe H.Background: Health literacy is a determinant of health and assessed globally to inform the development of health interventions. However, little is known about health literacy in countries with one of the poorest health indicators worldwide, such as Afghanistan. Studies worldwide demonstrate that women play a key role in developing health literacy. Hence, this study's purpose is to explore health literacy of women in Afghanistan and the associated factors. Methods: From May to June 2017, we randomly recruited 7-10 women per day at the hospital in Ghazni, a representative province of Afghanistan. Two trained female interviewers interviewed 322 women (15-61 years old) orally in Dari or Pashto on a voluntary basis and assessed their health literacy using the HLS-EU-Q16, associated socio-demographics, and health behavior. Results: Health literacy of women (among educated and illiterates) is low even compared to other Asian countries. Health literacy is linked to age and education. We found mixed evidence of the relationship between health literacy and contextual factors, help-seeking, and health-related behavior. Conclusion: This study provides novel data on health literacy and astonishing insights into its association with health behavior of women in Afghanistan, thus contributing to health status. The study calls for recognition of health literacy as a public health challenge be addressed in Afghanistan and other low-income countries affected by crises.
- Functional health literacy : psychometric properties of the newest vital sign for Portuguese adolescents (NVS-PTeen)Publication . Santos, Osvaldo; Stefanovska, Miodraga; Virgolino, Ana; Miranda, Ana Cristina; Costa, Joana; Fernandes, Elisabete; Cardoso, Susana; Carneiro, António VazSelf-management of health requires skills to obtain, process, understand, and use health-related information. Assessment of adolescents’ functional health literacy requires valid, reliable, and low-burden tools. The main objective of this study was to adapt and study the psychometric properties of the Newest Vital Sign for the Portuguese adolescents’ population (NVS-PTeen). Classic psychometric indicators of reliability and validity were combined with item response theory (IRT) analyses in a cross-sectional survey, complemented with a 3-month test-retest assessment. The NVS-PTeen was self-administered to students enrolled in grades 8 to 12 (12 to 17 years old) in a school setting. Overall, 386 students (191 girls) from 16 classes of the same school participated in the study (mean age = 14.5; SD = 1.5). Internal reliability of the NVS-PTeen was α = 0.60. The NVS-PTeen total score was positively and significantly correlated with Portuguese (r = 0.28) and mathematics scores (r = 0.31), school years (r = 0.31), and age (r = 0.19). Similar to the original scale (for the U.S.), the NVS-PTeen is composed of two dimensions, reading-related literacy and numeracy. Temporal reliability is adequate, though with a learning effect. IRT analyses revealed differences in difficulty and discriminative capacity among items, all with adequate outfit and infit values. Results showed that the NVS-PTeen is valid and reliable, sensible to inter-individual educational differences, and adequate for regular screening of functional health literacy in adolescents.
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