A hospital-based study

Newborn mortality and adverse birth outcomes (ABOs) in Sao Tome & Prı´ncipe (STP) are overwhelmingly high, and access to quality-antenatal care (ANC) is one of the strategies to tackle it. This study aimed to fill the gaps in ANC screenings with a focus on how to improve neonatal outcomes. We conducted a retrospective hospital-based study in which ANC pregnancy cards were reviewed. Screenings were described and compared according to the total number of ANC contacts: 1–3 (inadequate), 4–7 (adequate), and �8 (complete). The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Statistical significance was considered at a p-value �0.05. A total of 511 ANC pregnancy cards were reviewed. Mothers’ mean age was 26.6 (SD = 7.1), 51.7% had a first trimester early booking, 14.9% (76) had 1–3 ANC contacts, 46.4% (237) had 4–7 and 38.7% (198) �8. Screening absence was found in 24%-41%, lack of money was registered in 36%. Pregnant women had no screening performed for HIV in 4.5%, syphilis in 8.8%, HBV 39.3%, malaria 25.8%, hemoglobin 24.5%, blood glucose 45.4%, urine 29.7%, stool exams 27.8% and 41.1% had no ultrasound. Screening completion for blood group, HIV, malaria, urine, hemoglobin, and coproparasitological exam were found to have a statistically significant difference (ppublishersversionpublishe

Environment and health in children day care centers

This project addresses a set of common clinical problems in the context of children attending day care centres. It is common sense that children get sick more often as soon as they start attending a day care centre on a daily basis and this is particularly true for some groups at risk, as wheezing infants and wheezing pre-school childreninfo:eu-repo/semantics/publishedVersio

The risk of distant metastases in patients with clinical complete response managed by watch and wait after neoadjuvant therapy for rectal cancer: the influence of local regrowth in the International Watch and Wait Database

BACKGROUND: Nearly 30% of patients with rectal cancer develop local regrowth after initial clinical complete response managed by watch and wait. These patients might be at higher risk for distant metastases.OBJECTIVE: This study aimed to investigate risk factors for distant metastases using time-dependent analyses.DESIGN: Data from an international watch and wait database were retrospectively reviewed. Cox regression analysis was used to determine risk factors for worse distant metastases-free survival. Conditional survival modeling was used to investigate the impact of risk factors on the development of distant metastases.SETTING: Retrospective, multicenter database.PATIENTS: A total of 793 patients (47 institutions) with rectal cancer and clinical complete response to neoadjuvant treatment from the International Watch & Wait Database were included.MAIN OUTCOME MEASURES: Distant metastases-free survival.RESULTS: Of the 793 patients managed with watch and wait (median follow-up 55.2 mo)‚ 85 patients (10.7%) had distant metastases. Fifty-one of 85 patients (60%) had local regrowth at any time. Local regrowth was an independent factor associated with worse distant metastases-free survival in the multivariable model. Using conditional estimates, patients with local regrowth without distant metastases for 5 years (from decision to watch and wait) remained at higher risk for development of distant metastases for 1 subsequent year compared to patients without local regrowth (5-year conditional distant metastases-free survival 94.9% vs 98.4%).LIMITATIONS: Lack of information on adjuvant chemotherapy, salvage surgery for local regrowth, and heterogeneity of individual surveillance/follow-up strategies used may have affected results.CONCLUSIONS: In patients with clinical complete response managed by watch and wait, development of local regrowth at any time is a risk factor for distant metastases. The risk of distant metastases remains higher for 5 years after development of local regrowth.Surgical oncolog

Modelação e projeção da incidência de cancro colo-rectal e do estômago no Sul de Portugal

O presente estudo tem como ojetivos: a modelação da incidência de cancro do cólon, reto e do estômago no período 1998-2006, com recurso aos modelos APC e a projeção da taxa de incidência no período 2007-2010 para as referidas neoplasias com base nos modelos APC e em modelos lineares, log-lineares e não lineares.N/

Acute exercise amplifies inflammation in obese patients with COPD

Systemic inflammation has been implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD) systemic effects. However, most COPD patients do not suffer from persistent systemic inflammation even after exacerbations and exercise and scientific evidence has provided conflicting results. Our aim is to evaluate inflammatory gene expression at rest and at 1 and 24 h after strenuous exercise in COPD patients and study the patient variables associated with inflammatory expression.A cross-sectional study was conducted in COPD patients who were recruited on entry to a pulmonary rehabilitation (PR) program. Demographic, clinical and functional data were collected. Blood samples were collected and gene expression was analyzed by reverse transcriptase polymerase chain reaction for IFNg, IL1b, IL6, IL8, TNFa, TGFb1 and iNOS.The study included 21 patients (15 men, 71.4%), mean age 66.1 years old (SD = 8.27), mean FEV1 46.76% (SD 20.90%), 67% belonging to GOLD grade D, mean BODE index of 3.9, 90.5% with smoking history, mean BMI 25.81 (SD = 4.87), median of 1.29 exacerbations in the previous year.There was no statistical significant difference between inflammatory expression at rest and at 1 h and 24 h after the maximal exercise test for all tested genes.We found an association between BMI and inflammatory expression at all the points of time checked, a slight inverse association occurs with low BMI for mRNA IL1b, IL6, TNFa, TGFb1 and iNOS, and there was a more pronounced positive association for obese patients for all tested genes.This preliminary study did not show an enhanced inflammatory gene expression from rest to 1 h and 24 h after short-term exercise, but did show an increased inflammatory gene expression in both BMI extremes, both at rest and after exercise, suggesting not only malnourishment, but also obesity as potential links between COPD and systemic inflammation. Studies with larger samples and designed to definitely exclude OSA or OHS as confounding factors in obese patients are required. Keywords: COPD, Inflammation, Exercise, Obesity, Reverse transcriptase polymerase chain reactio

Surgical risk evaluation of lung cancer in COPD patients â A cohort observational study

Coexistence between pulmonary cancer and chronic obstructive pulmonary disease (COPD) is frequent and is anticipated to be lead to high worldwide mortality in the next decades. The most powerful therapeutic approach for non-small cell lung carcinoma is lung surgical resection. However, in COPD patients, this approach bears a higher mortality and morbidity risk, thus requiring an accurate pre-operatory evaluation of the surgical risk comprising a clinical and functional assessment at rest, as well as a cardiopulmonary exercise test. In this observational study, factors associated with cardiopulmonary complications within 30 days after tumor resection surgery were investigated in a cohort of patients with COPD and lung cancer assigned to perform a cardiopulmonary exercise test.This study included 50 patients (46 men, 92.0%) with a mean age of 64.7 years old (standard deviation 7.9), forced expiratory volume in the first second (FEV1) of 61.8% (SD 19.0%) and carbon monoxide diffusing capacity (DLCO) of 46.0% (SD 14.8%).Complications were observed in eighteen patients (36.0%) including 2 deaths (4.0%). Peak oxygen uptake (VO2peak) expressed in percentage of the predicted value was the only parameter showing a statistically significant difference between the groups with and without complications (p = 0.027). The best value of VO2peak to discriminate complications occurrence was 61.0%.This study highlights the relevance of the cardiopulmonary exercise test in the risk assessment of pulmonary resection surgery in patients with COPD. The VO2peak (percentage of predicted value) is shown to be associated with complications within 30 days after surgery. Keywords: Chronic obstructive pulmonary disease, Lung cancer, Cardiopulmonary exercise testing, Postoperative complication

Supplementary Material for: Proposta de um Core Set Abreviado de Avaliação da Funcionalidade em Cuidados Pós-Agudos Geriátricos

<i>Objetivo:</i> Desenvolver um Core Set Geriátrico Abreviado para avaliação/intervenção da funcionalidade, em cuidados de reabilitação de contexto pós-agudo. <i>Materiais e Métodos:</i> Desenvolveu-se um estudo observacional do tipo analítico e longitudinal, que permitisse conhecer os domínios e as variáveis com maior valor preditivo e discriminativo relativamente à evolução da funcionalidade das condições de saúde observadas. Para a constituição da amostra consideraram-se os indivíduos com 65 ou mais anos, internados em unidades de Convalescença e Média Duração da Rede Nacional de Cuidados Continuados Integrados da região do Algarve. <i>Resultados:</i> A amostra foi constituída por 451 indivíduos, com uma média de idade 79,5 ± 7,5 anos, dos quais 62,1% eram mulheres. As condições de saúde com frequências mais elevadas como causa de admissão na Rede foram as fraturas da extremidade superior do fémur e os acidentes vasculares encefálicos que no seu conjunto equivaleram a 73,6% dos casos. Das 21 variáveis independentes que integraram os modelos explicativos da funcionalidade foi possível organizar uma listagem de 28 categorias: 5 Funções, 16 Atividades/Participação e 7 Fatores Ambientais.<i> Conclusões:</i> A presente proposta de Core Set Geriátrico Abreviado para os cuidados de reabilitação de contexto pós-agudo tem um enfoque sobretudo no componente Atividades/Participação, enquanto componente que materializa de forma concreta a interação do indivíduo com o meio e a sua vida real. A funcionalidade deve ser considerada uma variável incontornável da Saúde Pública pelo facto de permitir reproduzir as deficiências e limitações dos indivíduos, mas igualmente facilitar a alocação estruturada de equipamentos, serviços e sistemas, promotores da sua participação

Environment and Health in Children Day Care Centres in Portugal - results from phase II on the ventilation characteristics of 16 schools

Publicado em: Proceedings of CLIMA 2013 : 11th REHVA World Congress and the 8th International Conference on Indoor Air Quality, Ventilation and Energy Conservation in Buildings ; Prague 16th - 19th June, 2013, Paper ID 876

Environment and Health in Children Day Care Centres (ENVIRH) â Study rationale and protocol

Background: Indoor air quality (IAQ) is considered an important determinant of human health. The association between exposure to volatile organic compounds, particulate matter, house dust mite, molds and bacteria in day care centers (DCC) is not completely clear. The aim of this project was to study these effects. Methods â study design: This study comprised two phases. Phase I included an evaluation of 45 DCCs (25 from Lisbon and 20 from Oporto, targeting 5161 children). In this phase, building characteristics, indoor CO2 and air temperature/relative humidity, were assessed. A children's respiratory health questionnaire derived from the ISAAC (International Study on Asthma and Allergies in Children) was also distributed. Phase II encompassed two evaluations and included 20 DCCs selected from phase I after a cluster analysis (11 from Lisbon and 9 from Oporto, targeting 2287 children). In this phase, data on ventilation, IAQ, thermal comfort parameters, respiratory and allergic health, airway inflammation biomarkers, respiratory virus infection patterns and parental and child stress were collected. Results: In Phase I, building characteristics, occupant behavior and ventilation surrogates were collected from all DCCs. The response rate of the questionnaire was 61.7% (3186 children).Phase II included 1221 children. Association results between DCC characteristics, IAQ and health outcomes will be provided in order to support recommendations on IAQ and children's health. A building ventilation model will also be developed. Discussion: This paper outlines methods that might be implemented by other investigators conducting studies on the association between respiratory health and indoor air quality at DCC. Resumo: Antecedentes: A qualidade do ar interior (IAQ) é considerada um determinante importante da saúde humana. A associação entre a exposição a compostos orgânicos voláteis, partículas, ácaros, bolores e bactérias em creches (DCC) não é perfeitamente clara. O objectivo deste estudo foi estudar esses efeitos. Metodologia â desenho do estudo: Este estudo decorreu em duas Fases. A Fase I incluiu uma avaliação de 45 DCCs (25 em Lisboa e 20 no Porto, visando 5.161 crianças). Nesta Fase, foram avaliadas as características dos edifícios, o CO2 e a temperatura ambiente/humidade relativa no interior. Também foi distribuído um questionário de saúde respiratória das crianças derivado do ISAAC (Estudo Internacional sobre a Asma e Alergias em Crianças). A Fase II englobou duas avaliações e incluiu 20 DCCs seleccionadas da fase I, após uma análise de clusters (11 em Lisboa e 9 no Porto, visando 2.287 crianças). Nesta Fase, foram recolhidos dados sobre a ventilação, IAQ (qualidade do ar interior), parâmetros de conforto térmico, saúde em termos respiratórios e alérgicos, marcadores biológicos de inflamação das vias respiratórias, padrões de infecção de vírus respiratórios e stress dos pais e crianças. Resultados: Na Fase I, foram recolhidas as características dos edifícios, o comportamento dos ocupantes e os marcadores de ventilação, para todas as DCCs. A taxa de resposta ao questionário foi de 61,7% (3.186 crianças).A Fase II incluiu 1.221 crianças. Os resultados da associação entre as características dos DCC, a IAQ e os resultados para a saúde serão fornecidos para apoiar as recomendações sobre a IAQ e a saúde das crianças. Um modelo de ventilação de edifícios também será desenvolvido. Discussão: Este documento destaca a metodologia que pode ser implementada por outros investigadores que realizam estudos sobre a associação entre a saúde respiratória e a qualidade do ar interior, em creches e infantários. Keywords: Airway inflammation, Building ventilation, Children day care centers, Environmental exposure, Indoor air quality, Respiratory disease, Palavras-chave: Inflamação das vias respiratórias, Ventilação de edifícios, Creches, Exposição ambiental, Qualidade do ar interior, Doença respiratóri