results from a nationwide population-based study

Funding Information: This study is funded by national funds through FCT - Fundação para a Ciência e Tecnologia, I. P. under the PhD grant SFRH/BD/148420/2019 awarded to the first author. This protocol was included in the PhD previously approved project. EpiReumpaPt was supported by unrestricted grants from Direcção-Geral da Saúde, Fundação Calouste Gulbenkian, Fundação Champalimaud, Fundação AstraZeneca, AbbVie, Merck, Sharp & Dohme, Pfizer, Roche, Servier, Bial, D3A Medical Systems, Happybrands, Center de Medicina Laboratorial Germano de Sousa, Clínica Médica da Praia da Vitória, CAL-Clínica, Galp Energia, Açoreana Seguros, and individual rheumatologists.Background: Worldwide, the current management of knee osteoarthritis appears heterogeneous, high-cost and often not based on current best evidence. The absence of epidemiological data regarding the utilisation of healthcare services may conceal the need for improvements in the management of osteoarthritis. The aim of this study is to explore the profiles of healthcare services utilisation by people with knee osteoarthritis, and to analyse their determinants, according to Andersen’s behavioural model. Methods: We analysed a sample of 978 participants diagnosed with knee osteoarthritis from the population-based study EpiReumaPt, in Portugal. Data was collected with a structured interview, and the diagnosis of knee osteoarthritis was validated by a rheumatologist team. With the Two-step Cluster procedure, we primarily identified different profiles of healthcare utilisation according to the services most used by patients with knee osteoarthritis. Secondly, we analysed the determinants of each profile, using multinomial logistic regression, according to the predisposing characteristics, enabling factors and need variables. Results: In our sample, a high proportion of participants are overweight or obese (82,6%, n = 748) and physically inactive (20,6%, n = 201) and a small proportion had physiotherapy management (14,4%, n = 141). We identified three profiles of healthcare utilisation: “HighUsers”; “GPUsers”; “LowUsers”. “HighUsers” represents more than 35% of the sample, and are also the participants with higher utilisation of medical appointments. “GPUsers” represent the participants with higher utilisation of general practitioner appointments. Within these profiles, age and geographic location – indicated as predisposing characteristics; employment status and healthcare insurance - as enabling factors; number of comorbidities, physical function, health-related quality of life, anxiety and physical exercise - as need variables, showed associations (p < 0,05) with the higher utilisation of healthcare services profiles. Conclusions: Healthcare utilisation by people with knee osteoarthritis is not driven only by clinical needs. The predisposing characteristics and enabling factors associated with healthcare utilisation reveal inequities in the access to healthcare and variability in the management of people with knee osteoarthritis. Research and implementation of whole-system strategies to improve equity in the access and quality of care are paramount in order to diminish the impact of osteoarthritis at individual-, societal- and economic-level.publishersversionpublishe

Advances in electrochemical reduction of CO2 in ionic liquid-based electrolytes [Resumo]

ABSTRACT: Electrochemical reduction of CO2 was for the first time reported in 1870 [1], but it was only after 2010 that this field was the subject of intense research efforts. The use of renewable electricity to convert CO2 into products that are currently derived from fossil products and have high carbon footprint will certainly make this technology one pillar of a sustainable chemical industry. The scepticism towards the availability of cost effective products derived from CO2 electro-reduction that customers will be willing to buy has shifted to the belief that they can be commercially viable. Turning electrochemical CO2 reduction into a commercial technology will depend on economics, on the price of electricity, efficiency of the process and the value of the products. One way to improve the economics and improve the efficiency of the process is to integrate CO2 capture with conversion [2,3]. In this way the energy intensive regeneration step of the capture media can be eliminated and also CO2 transportation and storage. Ionic liquids are ideal media to achieve this integration, due to high CO2 adsorption capacity, high selectivity, wide electrochemical windows and nearly zero vapour pressure. The present work reports the progress of electrochemical reduction of CO2 in ionic liquids and the work of the authors in this field. It has been recognized that ionic liquids promote CO2 electro-reduction through lowering the reduction potential, the suppression of the competing hydrogen evolution reaction and by increasing the selectivity towards the target products. However, the understanding of the interactions between ionic liquids, CO2 and catalyst is still quite limited, but fundamental for synthetizing more efficient electrolytes for CO2 electro-reduction [4]. Thus, current cation and anion effects will be analysed and an overview of the current performance of heterogeneous electro-catalysts in ionic liquid- based electrolytes for CO2 electro-reduction will be provided.N/

A Cross-Sectional Population-Based Study

Funding Information: We thank the EpiDoc Unit and EpiReumaPt team for conceptualising, planning, and implementing the main research project. We would like to acknowledge that the present publication was supported by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). Funding Information: This work was supported by an independent research grant from Pfizer. DC received national funding through FCT—Fundação para a Ciência e Tecnologia, I. P. under the Ph.D. grant SFRH/BD/148420/2019Background: Hip/knee osteoarthritis (HKOA) is a leading cause of disability and imposes a major socioeconomic burden. The aim of this study is to estimate the prevalence of HKOA in Portugal, characterised the clinical severity of HKOA in the population, and identified sociodemographic, lifestyle, and clinical factors associated with higher clinical and radiographic severity. Methods: Participants with a diagnosis of HKOA from the EpiReumaPt study (2011–2013) were included (n = 1,087). Hip/knee osteoarthritis diagnosis was made through a structured evaluation by rheumatologists according to American College of Rheumatology criteria. Clinical severity was classified based on Hip Disability and Osteoarthritis Outcome Scale (HOOS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) score tertiles. Radiographic severity was classified based on the Kellgren-Lawrence grades as mild, moderate, or severe. Sociodemographic lifestyle and clinical variables, including the presence of anxiety and depression symptoms, were analysed. Factors associated with higher clinical and radiographic severity were identified using ordinal logistic regression models. Results: Hip/knee osteoarthritis diagnosis was present in 14.1% of the Portuguese population [12.4% with knee osteoarthritis (OA) and 2.9% with hip OA]. Clinical severity was similar between people with hip (HOOS = 55.79 ± 20.88) and knee (KOOS = 55.33 ± 20.641) OA. People in the high HOOS/KOOS tertile tended to be older (64.39 ± 0.70 years), female (75.2%), overweight (39.0%) or obese (45.9%), and had multimorbidity (86.1%). Factors significantly associated with higher clinical severity tertile were age [55–64 years: odds ratio (OR) = 3.18; 65–74 years: OR = 3.25; ≥75 years: OR = 4.24], female sex (OR = 1.60), multimorbidity (OR = 1.75), being overweight (OR = 2.01) or obese (OR = 2.82), and having anxiety symptoms (OR = 1.83). Years of education was inversely associated with higher clinical severity. Factors significantly associated with higher radiographic severity were age (65–74 years: OR = 3.59; ≥75 years: OR = 3.05) and being in the high HOOS/KOOS tertile (OR = 4.91). Being a female and live in Lisbon or in the Centre region were inversely associated with the higher radiographic severity. Conclusion: Hip/knee osteoarthritis is present in ~1.1 million of Portuguese people. Age, educational level, and obesity are independently associated with HKOA clinical severity, whereas age, sex, geographic location, and clinical severity are independently associated with radiographic severity.publishersversionpublishe

Intrasellar Chondroid Chordoma: A Case Report

Chordomas are tumors derived from cells that are remnants of the notochord, particularly from its proximal and distal extremes, they are mainly midline and represent approximately 1% of all malignant bone tumors and 0.1 to 0.2% of intracranial neoplasms. Chordomas involving the sellar region are rare. Herein, we describe a 57-year-old male patient presenting with a history of retro-orbital headache, progressive loss of vision, and clinical features of hypopituitarism, for over 2 months. During evaluation, the CT scan revealed a large contrast-enhancing intrasellar tumor with a 3.6-cm largest diameter. The patient underwent transsphenoidal partial resection of the tumor, and histological examination was consistent with the diagnosis of chondroid chordoma. Although chordomas are rare, they may be considered to constitute a differential diagnostic of pituitary adenomas, especially if a calcified intrasellar tumor with bone erosion is diagnosed

a scoping review protocol

Funding Information: This project is funded by National funds through FCT-Fundacao para a Ciencia e Tecnologia, I. P. under the PhD grant SFRH/BD/148420/2019 awarded to the first author. This protocol was included in the PhD previously approved project. Funding Information: Funding This project is funded by national funds through FCT-Fundação para a Ciência e Tecnologia, I. P. under the PhD grant SFRH/BD/148420/2019 awarded to the first author. This protocol was included in the PhD previously approved project. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.Introduction Knee osteoarthritis (OA) is a prevalent condition with associated high disability and healthcare costs. Evidence of major gaps in the implementation of evidence-based interventions in people with knee OA led several healthcare systems to implement models of care (MoCs) in order to improve knowledge translation and guaranty their economic sustainability. Nevertheless, there are few studies that analyse the existing body of evidence of MoCs for patients with knee OA in primary healthcare settings. Therefore, we aim to identify MoCs developed for patients with knee OA implemented in primary healthcare and, analyse their core components and outcomes. This scoping review will create knowledge about the components and outcomes of these MoCs which, in the future, will facilitate their transferability to practice. Methods and analysis We will include studies that developed and implemented an MoC for people with knee OA in primary healthcare. We will use the PCC mnemonic, being 'Population' -people with Knee OA, 'Concept' -the MoCs and 'Context' -the primary healthcare setting. We will conduct the search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, as well as grey literature databases and relevant institutions and organisations websites, for articles published after 2000. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess papers regarding their eligibility. We will evaluate the methodological quality of the included studies with the Mixed Methods Appraisal tool and apply a data abstraction form to describe and interpret the evidence. Ethics and dissemination As a secondary analysis, this scoping review does not require ethical approval. Findings will be published in peer-review journal, presented in scientific conferences and as a summary through primary healthcare units.publishersversionpublishe

A bio-based alginate aerogel as an ionic liquid support for the efficient synthesis of cyclic carbonates from co2 and epoxides

Funding Information: This work was supported by Ministerio de Ciencia y Universidades (project RTI2018-097456-B-I00) and Funda??o para a Ci?ncia e Tecnologia FCT/MCTES (project PTDC/EQU-EPQ/31926/2017), UIDB/50006/2020 of the Associate Laboratory for Green Chemistry?LAQV and UIDB/00100/2020 of Centro de Qu?mica Estrutural. This work was also supported by a Short Term Scientific Mission of the CMST COST Action CM1206. A.B. Paninho is thankful to FCT for the doctoral fellowship PD/BD/52497/2014 and pos-doctoral fellowship PTDC/EQU-EPQ/31926/2017. The authors also thanks to the project ?SunStorage-Harvesting and storage of solar energy?, with reference POCI-01-0145-FEDER-016387, funded by European Regional Development Fund (ERDF), through COMPETE 2020-Operational Program. The NMR spectrometers at FCT NOVA are part of Rede Nacional de RMN (PTNMR), supported by FCT/MCTES through ROTEIRO/0031/2013? PINFRA/22161/2016 and co-financed by FEDER through COMPETE 2020, POCI, and PORL and FCT/MCTES through PIDDAC.In this work, the ionic liquid [Aliquat][Cl] was supported into alginate and silica aerogel matrices and applied as a catalyst in the cycloaddition reaction between CO2 and a bio-based epoxide (limonene oxide). The efficiency of the alginate aerogel system is much higher than that of the silica one. The method of wet impregnation was used for the impregnation of the aerogel with [Aliquat][Cl] and a zinc complex. The procedure originated a well-defined thin solvent film on the surface of support materials. Final materials were characterised by Fourier Transform Infrared Spectroscopy, N2 Adsorption–Desorption Analysis, X-ray diffraction, atomic absorption and Field Emission Scanning Microscopy. Several catalytic tests were performed in a high-pressure apparatus at 353.2 K and 4 MPa of CO2.publishersversionpublishe

a cross-sectional population-based study

Funding Information: We thank Prof. Carla Nunes (NOVA National School of Public Health – Universidade NOVA de Lisboa) for the valuable insights and discussions in the conceptualization of this project. We thank the EpiDoc Unit and EpiReumaPt team for conceptualizing, planning, and implementing the main research project. We also acknowledge the support of CHRC (UIDP/04923/2020), granted by national funds through Fundação Ciência e Tecnologia, IP. Funding Information: This study received funding from an independent research grant (ID: 64165707) by Pfizer, and the first author received a grant from Fundação Ciência e Tecnologia, IP under the PhD grant SFRH/BD/148420/2019. The funders were not involved in study design; collection, analysis, or interpretation of data; or writing this article or the decision to submit it for publication. Publisher Copyright: © 2023, The Author(s).Background: Pain due to knee and / or hip osteoarthritis (HKOA) is the most common symptom for seeking healthcare. Pain interferes on daily activities, social and occupational participation in people with HKOA. The goal of this study is to estimate the prevalence of unmanageable pain levels (UPL) among people with HKOA), characterize this population and identify factors associated with UPL, and compare therapeutic strategies used by people with UPL versus manageable pain levels (MPL). Methods: We analysed data from the EpiReumaPt study (n = 10,661), that included a representative sample of the Portuguese population. Among these, 1081 participants had a validated diagnosis of HKOA by a rheumatologist. Sociodemographic, lifestyle and health-related data were collected in a structured interview. Pain intensity (NPRS) data were collected in a medical appointment. Painmedication (last month), physiotherapy and surgery were considered as therapies for pain management. UPL was defined as a mean pain intensity in the previous week of ≥5 points on 11-point numeric pain rating scale. The factors associated with UPL were analyzed with logistic regression (p < 0.05, 95%CI). The effect of unmanageable pain levels was assessed by the HOOS/KOOS activities of daily living and quality of life subscales. Symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Analysis was completed with linear and logistic regression. All analysis were weighted. Results: The estimated prevalence of UPL among people with HKOA was 68.8%. UPL was associated with being female (odds ratio (OR) = 2.36, p < 0.001), being overweight (OR = 1.84, p = 0.035) or obese (OR = 2.26, p = 0.006), and having multimorbidity (OR = 2.08, p = 0.002). People with UPL reported worse performance in activities of daily living and lower quality of life (β = − 21.28, p < 0.001 and β = − 21.19, p < 0.001, respectively) than people with MPL. People with UPL consumed more NSAIDs (22.0%, p = 0.003), opioids (4.8%, p = 0.008), paracetamol (2.7%, p = 0.033), and overall analgesics (7.3%, p = 0.013) than people with MPL. A higher proportion of people with UPL underwent physiotherapy (17.5%, p = 0.002) than people with MPL. Conclusion: Two-thirds of people with HKOA in Portugal have poor management of their pain levels. Clinical and lifestyle factors, that are highly presented in individuals with HKOA, are associated with unmanageable pain. Our results highlighting the need for further research and implementation of effective interventions to improve pain, function and quality of life in people with HKOA.publishersversionpublishe

Cationic supramolecular hydrogels for overcoming the skin barrier in drug delivery

A cationic bis‐imidazolium‐based amphiphile was used to form thermoreversible nanostructured supramolecular hydrogels incorporating neutral and cationic drugs for the topical treatment of rosacea. The concentration of the gelator and the type and concentration of the drug incorporated were found to be factors that strongly influenced the gelling temperature, gel‐formation period, and overall stability and morphology. The incorporation of brimonidine tartrate resulted in the formation of the most homogeneous material of the three drugs explored, whereas the incorporation of betamethasone resulted in a gel with a completely different morphology comprising linked particles. NMR spectroscopy studies proved that these gels kept the drug not only at the interstitial space but also within the fibers. Due to the design of the gelator, drug release was up to 10 times faster and retention of the drug within the skin was up to 20 times more effective than that observed for commercial products. Experiments in vivo demonstrated the rapid efficacy of these gels in reducing erythema, especially in the case of the gel with brimonidine. The lack of coulombic attraction between the gelator-host and the guest-drug seemed particularly important in highly effective release, and the intermolecular interactions operating between them were found to lie at the root of the excellent properties of the materials for topical delivery and treatment of rosacea

A flow-through strategy using supported ionic liquids for L-asparaginase purification

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Stearic acid, beeswax and carnauba wax as green raw materials for the loading of carvacrol into nanostructured lipid carriers

The use of lipid nanoparticles as drug delivery systems has been growing over recent decades. Their biodegradable and biocompatible profile, capacity to prevent chemical degradation of loaded drugs/actives and controlled release for several administration routes are some of their advantages. Lipid nanoparticles are of particular interest for the loading of lipophilic compounds, as happens with essential oils. Several interesting properties, e.g., anti-microbial, antitumoral and antioxidant activities, are attributed to carvacrol, a monoterpenoid phenol present in the composition of essential oils of several species, including Origanum vulgare, Thymus vulgaris, Nigellasativa and Origanum majorana. As these essential oils have been proposed as the liquid lipid in the composition of nanostructured lipid carriers (NLCs), we aimed at evaluating the influence of carvacrol on the crystallinity profile of solid lipids commonly in use in the production of NLCs. Different ratios of solid lipid (stearic acid, beeswax or carnauba wax) and carvacrol were prepared, which were then subjected to thermal treatment to mimic the production of NLCs. The obtained binary mixtures were then characterized by thermogravimetry (TG), differential scanning calorimetry (DSC), small angle X-ray scattering (SAXS) and polarized light microscopy (PLM). The increased concentration of monoterpenoid in the mixtures resulted in an increase in the mass loss recorded by TG, together with a shift of the melting point recorded by DSC to lower temperatures, and the decrease in the enthalpy in comparison to the bulk solid lipids. The miscibility of carvacrol with the melted solid lipids was also confirmed by DSC in the tested concentration range. The increase in carvacrol content in the mixtures resulted in a decrease in the crystallinity of the solid bulks, as shown by SAXS and PLM. The decrease in the crystallinity of lipid matrices is postulated as an advantage to increase the loading capacity of these carriers. Carvacrol may thus be further exploited as liquid lipid in the composition of green NLCs for a range of pharmaceutical applications.This work was funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq/Brazil), the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/Brazil, FinanceCode 001), by the Portuguese Science and Technology Foundation (FCT/MCT) and European Funds (PRODER/COMPETE) under the projects M-ERA-NET/0004/2015 and UIDB/04469/2020 (strategic fund), co-financed by FEDER, under the Partnership Agreement PT2020.info:eu-repo/semantics/publishedVersio