Browsing by Issue Date, starting with "2022-01-04"
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- Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?Publication . Amado, Guilherme C.; Ferreira, Diogo; Nunes, A.Introduction: Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment. Objectives: This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access. Methods: We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access. Results: A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures. Conclusions: In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent growing trend in the number of studies suggests a promising future on the analysis of this topic.
- The Role of Rosmarinic Acid on the Bioproduction of Gold Nanoparticles as Part of a Photothermal Approach for Breast Cancer TreatmentPublication . Ferreira-Gonçalves, Tânia; Gaspar, Maria Manuela; Coelho, João M. P.; Marques, Vanda; Viana, Ana S.; Ascensão, Lia; Carvalho, Lina; Rodrigues, Cecília M. P.; Ferreira, Hugo Alexandre; Ferreira, David; Reis, Catarina PintoBreast cancer is a high-burden malignancy for society, whose impact boosts a continuous search for novel diagnostic and therapeutic tools. Among the recent therapeutic approaches, photothermal therapy (PTT), which causes tumor cell death by hyperthermia after being irradiated with a light source, represents a high-potential strategy. Furthermore, the effectiveness of PTT can be improved by combining near infrared (NIR) irradiation with gold nanoparticles (AuNPs) as photothermal enhancers. Herein, an alternative synthetic method using rosmarinic acid (RA) for synthesizing AuNPs is reported. The RA concentration was varied and its impact on the AuNPs physicochemical and optical features was assessed. Results showed that RA concentration plays an active role on AuNPs features, allowing the optimization of mean size and maximum absorbance peak. Moreover, the synthetic method explored here allowed us to obtain negatively charged AuNPs with sizes favoring the local particle accumulation at tumor site and maximum absorbance peaks within the NIR region. In addition, AuNPs were safe both in vitro and in vivo. In conclusion, the synthesized AuNPs present favorable properties to be applied as part of a PTT system combining AuNPs with a NIR laser for the treatment of breast cancer.
- Intermittent administration of peracetic acid is a mild environmental stressor that elicits mucosal and systemic adaptive responses from Atlantic salmon post-smoltsPublication . Osório, João; Stiller, Kevin T.; Reiten, Britt‑Kristin; Kolarevic, Jelena; Johansen, Lill‑Heidi; Afonso, Fernando; Lazado, Carlo C.Background: Fish encounter oxidative stress several times during their lifetime, and it has a pervasive infuence on their health and welfare. One of the triggers of oxidative stress in fsh farming is the use of oxidative disinfectants to improve rearing conditions, especially in production systems employing recirculation technology. Here we report the physiological and morphological adaptive responses of Atlantic salmon (Salmo salar L.) post-smolts to intermit tent exposure to a potent oxidative agent peracetic acid (PAA). Fish reared in semi-commercial scale brackish water recirculating aquaculture system (RAS) were exposed to 1ppm PAA every 3days over 6weeks. Mucosal and systemic responses were profled before exposure, 22 and 45days during the intermittent PAA administration. Results: Oxidative stress was likely triggered as plasma antioxidant capacity increased signifcantly during the expo sure period. Adaptive stress response to the periodic oxidant challenge was likewise demonstrated in the changes in plasma glucose and lactate levels. PAA-induced alterations in the transcription of antioxidants, cytokines, heat shock pro teins and mucin genes showed a tissue-specifc pattern: downregulation was observed in the gills and olfactory rosette, upregulation occurred in the skin, and no substantial changes in the liver. Further, PAA exposure resulted in histological changes in key mucosal organs (i.e. olfactory rosette, skin and gills); pathological alterations were predominant in the gills where cases of epithelial lifting, hypertrophy and clubbing were prevalent. In addition, intermittent PAA administration resulted in an apparent overproduction of mucus in the nasal mucosa. Lastly, PAA did not dramatically alter the ability of salmon to mount a physiological stress response in the presence of a secondary stressor, though some subtle interfer ence was documented in the kinetics and magnitude of plasma cortisol and glucose response post-stress. Conclusions: The present study collectively demonstrated that intermittent oxidant exposure was a mild environ mental stressor that salmon could mount strong adaptive responses at systemic and mucosal levels. The results will be valuable in optimising the rearing conditions of post-smolts in RAS, especially in adopting water treatment strate gies that do not considerably interfere with fsh health and welfare
- Collagen and microvascularization in placentas from young and older maresPublication . Silva, Ana Catarina Neto; Costa, Ana Luísa; Teixeira, Ana; Alpoim-moreira, Joana; Fernandes, Carina; Fradinho, M.J.; Rebordão, Maria Rosa; Silva, Elisabete; Ferreira da Silva, José; Bliebernicht, Miguel; Alexandre-Pires, Graça; Ferreira-Dias, GraçaIn older mares, increasing collagen fibers (fibrosis) in the endometrium and oviduct predisposes to sub-fertility and infertility. In this study, (i) gene transcription of collagen (qPCR: COL1A1, COL1A2, COL3A1, COL5A1); (ii) total collagen protein (hydroxyproline); (iii) collagen distribution (Picrosirius red staining; polarized light microscopy); and (iv) microvascular density (Periodic acid-Schiff staining), were evaluated in mares’ placenta, and related to mares age, and placenta and neonate weights. Samples were collected from the gravid horn, non-gravid horn, and body of the placenta from younger (n = 7), and older mares (n = 9) of different breeds. Transcripts of COL1A1, COL3A1 and COL5A1, total collagen protein, chorionic plate connective tissue thickness, and microvascularization increased in the gravid horn of older mares’ placentas, compared to the youngest (P < 0.05). Although in other species placenta fibrosis may indicate placental insufficiency and reduced neonate weight, this was not observed here. It appears that older fertile mares, with more parities, may develop a heavier, more vascularized functional placenta with more collagen, throughout a longer gestation, which enables the delivery of heavier foals. Thus, these features might represent morphological and physiological adaptations of older fertile mares’ placentas to provide the appropriate nutrition to the equine fetus.
- Influência das fontes de informação online sobre Saúde Animal nos titulares de animais de companhia e respetiva interação com o Médico VeterinárioPublication . Viana, Maria Leão; Niza, Maria Manuela Grave Rodeia EspadaCom o evoluir da tecnologia, a Internet tornou-se uma ferramenta primária à sociedade atual e uma fonte amplamente utilizada para pesquisas sobre saúde. As suas vantagens são inúmeras e podem ser úteis à Medicina Veterinária, mas a facilidade de acesso e a falta de controlo da informação na Internet pode levar os titulares a adquirir conceitos errados e a comprometer os cuidados do seu animal. Também a relação entre o titular e o animal de companhia evoluiu e tem-se vindo a vincular cada vez mais, podendo em alguns casos ser considerada antropomorfizada. O animal passou a ser visto como um membro da família e ganhou estatutos que priorizam e asseguram os seus direitos a cuidados de saúde e bem-estar. Acredita-se que os comportamentos relativos à saúde humana se espelhem também na saúde animal. Pouco ainda se sabe acerca do real impacto que as pesquisas sem aconselhamento ou consulta de um profissional veterinário têm na relação Titular-Animal-Médico Veterinário, mas pensa-se que a informação adquirida online pode ser uma aliada na abordagem de cuidados e comunicação centrados na relação. O presente estudo teve como objetivo investigar a utilização da Internet em pesquisas sobre saúde animal pelos titulares de animais de companhia portugueses, como estes classificam e confiam nas variadas fontes de informação e ainda identificar associação entre a informação adquirida e a sua relação e comunicação com o Médico Veterinário. Um inquérito online anónimo foi distribuído através de redes de comunicação social, do qual se conseguiu uma amostra heterogénea de titulares. Do total de 472 respostas conseguidas, apurou-se que a fonte de informação mais utilizada é o Médico Veterinário (93,64%), seguido pela Internet (66,31%). A maioria (52,58%) dos inquiridos afirmou não ser frequente a prática do uso da Internet para pesquisa sobre Saúde Animal, com 17,58% a não utilizar e 35% a utilizar apenas 1 a 3 vezes ao ano. Apurou-se que quanto maior o número de visitas ao Médico Veterinário, mais os titulares partilham as informações pesquisadas com o seu Médico Veterinário. Quanto à prescrição de informação por parte do Médico Veterinário, 77% dos titulares afirmou não acontecer no seu caso, estando a maioria dos inquiridos dispostos (66,53% sim e 29,45% talvez) a investigar nas fontes recomendadas. Por fim, a amostra estudada revelou estar sensibilizada para os potenciais riscos das falhas de informação das suas pesquisas na saúde dos seus animais e nas consequências para a saúde pública.