Concentrações de mercúrio em aves de rapina diurnas em Portugal

Mercury is one of the most harmful non-essential elements to wildlife for its ability to bioaccumulate and bioamplify throughout the food chain. Due to the continuous increase in concentration of this element, birds of prey are often used as biomonitors due to their wide habitat diversity and high probability of contaminant accumulation as top predators. In the present work, the concentration of mercury in 10 tissues (nails, beak, feathers, liver, kidneys, lungs, heart, muscle, brain and skin) of four birds of prey was analyzed: common buzzard (Buteo buteo) , eurasian sparrowhawk (Accipiter nisus), common kestrel (Falco tinnunculus) and little owl (Athene noctua) and evaluated the influence of parameters such as gender and age on the accumulation of this element. The results showed significant differences between tissues in the order of concentrations: skin < brain< muscle < heart < lungs < liver < kidneys < feathers < nails < beak. Significant differences were observed between the different species, in which the eurasian sparrowhawk and the common buzzard presented the highest values. The age group influenced the accumulation in the common kestrel, where subadults presented higher values than those shown in adults, with no differences regarding gender. For the remaining bird species no significant differences were identified for variation of accumulation with gender or age.O mercúrio é um dos elementos não-essenciais mais prejudiciais à vida selvagem, pela sua capacidade de bioacumular e bioamplificar ao longo da cadeia alimentar. Devido ao contínuo aumento de concentração deste elemento, as aves de rapina são frequentemente utilizadas como biomonitores devido à sua vasta diversidade de habitats e elevada probabilidade de acumulação de contaminantes por serem predadores de topo. No presente trabalho foi analisada a concentração de mercúrio em 10 tecidos (unhas, bico, penas, fígado, rins, pulmões, coração, músculo, cérebro e pele) de quatro aves de rapina: águia-d’asa-redonda (Buteo buteo), gavião-europeu (Accipiter nisus), peneireiro-comum (Falco tinnunculus) e mocho-galego (Athene noctua) e avaliada a influência de parâmetros como género e idade na acumulação deste elemento. Os resultados obtidos evidenciaram diferenças significativas entre os tecidos, pela ordem de concentrações: pele < cérebro < músculo < coração < pulmões < fígado < rins < penas < unhas < bico. Foram observadas diferenças significativas entre as diferentes espécies, em que o gavião-europeu e a águia-d’asa-redonda apresentaram os valores mais elevados. A faixa etária influenciou na acumulação no peneireiro-comum, em que subadultos apresentaram valores superiores aos demonstrados nos adultos, não sendo observadas diferenças em relação ao género. Para as restantes espécies de aves não foram identificadas diferenças significativas para a variação da acumulação com o género ou idade.Mestrado em Ecologia Aplicad

A multifuncionalidade no desenvolvimento de uma bicicleta infantil

Mestrado em Engenharia e Design do ProdutoO presente trabalho tem como objetivo o desenvolvimento de um veículo de apoio à mobilidade de uma criança, desde o nascimento até aos 6 anos de idade. Com o crescimento e o desenvolvimento da motricidade das crianças, surge a necessidade de novos produtos para a mobilidade das mesmas e que por sua vez proporcionam o desenvolvimento saudável dos músculos e ossos, contudo, a maioria destes produtos tem um período de utilização curto, assim, o desafio deste trabalho foi desenvolver uma estrutura que permitisse as funções carrinho de bebé, triciclo e bicicleta. Por forma a conseguir um conceito com potencial de desenvolvimento, o método utilizado passou pela aquisição de informação sobre o desenvolvimento infantil, a contextualização histórica desse tipo de produtos e na análise de mercado. Terminada esta fase, iniciou-se o projeto, partindo do desenvolvimento conceptual para o desenvolvimento de sistemas e soluções construtivas seguindo-se o projeto de detalhe e dimensionamento que tem como objetivo assegurar a funcionalidade e o fabrico do conceito proposto.The present work aims to develop a vehicle to support mobility of a child from birth to 6 years old. With the growth and development of children motor skills, there is a need for new products to the mobility of these and which in turn provide the healthy development of muscles and bones. However, most of these products have a short period of use, thereby the challenge of this work was to develop a structure that would allow the functions stroller, tricycle and bicycle. In order to achieve a concept with potential for development, the method has the acquisition of information on child development, the historical context of this type of product and market analysis. Once this stage we started the project, from conceptual development to systems development and construction solutions following the project detail and design that aims to ensure the functionality and manufacture of the proposed concept

Adverse drug reactions in hospitals: population estimates for Portugal and the ICD-9-CM to ICD-10-CM crosswalk

© The Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Adverse drug reactions (ADR), both preventable and non-preventable, are frequent and pose a significant burden. This study aimed to produce up-to-date estimates for ADR rates in hospitals, in Portugal, from 2010 to 2018. In addition, it explores possible pitfalls when crosswalking between ICD-9-CM and ICD-10-CM code sets for ADR identification. Methods: The Portuguese Hospital Morbidity Database was used to identify hospital episodes (outpatient or inpatient) with at least one ICD code of ADR. Since the study period spanned from 2010 to 2018, both ICD-9-CM and ICD-10-CM codes based on previously published studies were used to define episodes. This was an exploratory study, and descriptive statistics were used to provide ADR rates and summarise episode features for the full period (2010-2018) as well as for the ICD-9-CM (2010-2016) and ICD -10-CM (2017-2018) eras. Results: Between 2010 and 2018, ADR occurred in 162,985 hospital episodes, corresponding to 1.00% of the total number of episodes during the same period. Higher rates were seen in the oldest age groups. In the same period, the mean annual rate of episodes related to ADR was 174.2/100,000 population. The episode rate (per 100,000 population) was generally higher in males, except in young adults (aged '15-20', '25-30' and '30-35' years), although the overall frequency of ADR in hospital episodes was higher in females. Conclusions: Despite the ICD-10-CM transition, administrative health data in Portugal remain a feasible source for producing up-to-date estimates on ADR in hospitals. There is a need for future research to identify target recipients for preventive interventions and improve medication safety practices in Portugal.This work was produced with the computational support of INCD – Instituto Nacional de Computação Distribuida – which is funded by Fundação para a Ciência e Tecnologia and FEDER under project 01/SAICT/2016 No. 022153. This publication was supported by Funds from Fundação para a Ciência e Tecnologia to the Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa (UIDB/04295/2020).info:eu-repo/semantics/publishedVersio

Real-world evidence on heart failure: findings from 25 thousand patients in a portuguese primary care database

Background: Heart failure (HF) is a major health problem in developed coun- tries, accounting for a significant social and economic burden. Published estimates of costs associated with HF patients in the primary care setting are scarce. Purpose: To determine the clinical and demographic characteristics of adult patients with a HF diagnosis in a Portuguese primary care comprehen- sive administrative database and to estimate the associated annual costs per patient. Methods: Population-based study with real data covering a population of 3.6 million patients attending primary care services in a large health region in Portugal. All adult users coded for HF with at least one visit in 2014 were selected. We analyzed patients’ characteristics, comorbidities (anemia, diabetes, hypertension, cere- brovascular disease, atrial fibrillation, ischemic heart disease, cardiomyopathies, valve disease, chronic obstructive pulmonary disease, pulmonary embolism, alco- hol abuse), and resource use in 2014 related to medical tests and cardiovascular diagnostic procedures, visits and cardiovascular or anticoagulant medication. Unit costs estimates were based on national sources. Results: We identied 25,337 patients, with an estimated HF prevalence of 1.4%. This is approximately 30% of number expected according to a previously conducted national community-based epidemiological survey. The difference may be explained by both underdiagnosis and underregistration. Patients with HF are mostly women (58%) and on average 77 ± 11 years old. The large majority of patients (93%) had at least one of the selected comorbidities present, 70% had 2 or more and 38% had 3 or more. About two thirds of patients (65%) had at least one medical test or diagnostic procedure done during 2014. Blood tests, echocardiogram, elec- trocardiogram and chest x-ray were performed in 61%, 16%, 14% and 11% of patients, respectively. The majority of patients (56%) had at least four office visits during one year. Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, beta-blockers, and aldosterone blockers were prescribed for 80%, 48% and 20% of patients, respectively. Only 12% of patients were prescribed all three drug classes. The average annual cost per patient was estimated at €552 ± 348, of which 54%, 40% and 6% was associated to medications, medical visits and medical tests or diagnostic procedures, respectively. Conclusions: This study provides a characterization of patients with HF in a large population in a primary care setting. Surprisingly 70% of the expected number of patients are either not diagnosed or not registered. HF patients are old, mostly women and characterized by multimorbidity. The average annual cost per patient was estimated to be about €550.info:eu-repo/semantics/publishedVersio

Generalization of the results of clinical studies through the analysis of subgroups

Copyright © Ordem dos Médicos 2012Subgroup analysis in clinical trials are usually performed to define the potential heterogeneity of treatment effect in relation with the baseline risk, physiopathology, practical application of therapy or the under-utilization in clinical practice of effective interventions due to uncertainties of its benefit/risk ratio. When appropriately planned, subgroup analysis are a valid methodology the define benefits in subgroups of patients, thus providing good quality evidence to support clinical decision making. However, in order to be correct, subgroup analysis should be defined a priori, done in small numbers, should be fully reported and, most important, must endure statistical tests for interaction. In this paper we present an example of the treatment of post-menopausal osteoporosis, in which the benefits of an intervention (the higher the fracture risk is, the better the benefit is) with a specific agent (bazedoxifene) was only disclosed after a post-hoc analysis of the initial global trial sample.As análises de subgrupos em ensaios clínicos são habitualmente efectuadas para definir a potencial heterogeneidade do efeito do tratamento relacionado com o risco de base ou da fisiopatologia, com a aplicação prática da terapêutica ou ainda da subutilização da terapêutica na prática clínica de rotina devido a incerteza do benefício/risco desta. Quando apropriadamente planeadas, as análises de subgrupos são metodologias válidas para discernir benefícios terapêuticos em subgrupos de doentes, fornecendo desta maneira evidência de boa qualidade de suporte à decisão clínica. No entanto, para a sua realização ser correcta devem ser indicadas a priori no protocolo inicial, devem restringir-se ao outcome primário, devem ser feitos em número limitado, devem ser todas reportadas e, mais importante, devem ser submetidas a testes estatísticos de interacção. Neste artigo apresentamos um exemplo no tratamento da osteoporose pós-menopáusica, em que o benefício de uma intervenção (quanto mais elevado o risco de fractura, maior o benefício do tratamento) com um agente específico (o bazedoxifeno) só foi esclarecido com uma análise posthoc de toda a amostra do estudo inicial.info:eu-repo/semantics/publishedVersio

Drug therapy for chronic heart failure due to left ventricular systolic dysfunction. II. Diuretics

Diuretics (particularly loop diuretics) are usually considered the first-line treatment for patients with chronic heart failure (CHF). The aldosterone antagonists, spironolactone and eplerenone, which are not unanimously classified as diuretics, have recently been included in therapy for CHF. Diuretics are the only drugs able to reduce fluid retention in CHF, although they are unable to maintain clinical stability for long periods of time when used in isolation. This article reviews the most valid and recent evidence available, based exclusively on large randomized controlled trials and systematic reviews and meta-analyses selected from secondary sources, on the use of diuretics in CHF with left ventricular systolic dysfunction.Os diuréticos (nomeadamente os diuréticos de ansa) são actualmente considerados a terapêutica de primeira linha para doentes com insuficiência cardíaca crónica (ICC). Os antagonistas da aldosterona - espironolactona e eplerenona - cuja classificação como diuréticos não é actualmente consensual, têm também sido recentemente propostos como terapêutica da ICC. Os diuréticos são os únicos fármacos capazes de controlar a retenção de fluidos da insuficiência cardíaca, não sendo contudo capazes de, isoladamente, manter a estabilidade clínica dos doentes por longos períodos de tempo. Este artigo tem como objectivo rever a evidência mais válida e actualmente disponível, baseada apenas em ensaios clínicos aleatorizados e controlados de grandes dimensões e revisões sistematizadas e/ou meta-análises publicadas, obtidos através de pesquisa em fontes secundárias, sobre a utilização de diuréticos na ICC por disfunção sistólica do ventrículo esquerdo.info:eu-repo/semantics/publishedVersio

Quality of life in patients with inflammatory bowel disease: the role of positive psychological factors

OBJECTIVE: To identify differences in quality of life (QoL) of patients with inflammatory bowel disease (IBD) between diagnosis (Crohn’s Disease and Ulcerative Colitis), gender (male and female), treatment condition (with and without surgery), and attachment styles (secure, preoccupied, and disconnected); to examine associations between QoL, sociodemographic, clinical, and positive psychological variables; to determine whether sociodemographic, clinical, and positive psychological variables predict QoL. METHOD: The sample included 70 participants diagnosed with IBD (Mage = 43.37 years, SD = 12.81), of whom 71.4% were females and 67.1% had Crohn’s Disease. Positive psychological variables (meaning in life, positive body image, and attachment styles), sociodemographic (age, education, gender) and clinical variables (diagnosis, disease duration, surgery) were assessed as independent variables. QoL was the dependent variable, analyzed through four domains (physical, psychological, social, environment). RESULTS: Participants with a secure attachment style reported higher QoL (physical, psychological, and social) than participants with a preoccupied attachment style. Strong positive correlations were found between positive psychological variables and QoL. Body appreciation was a significant predictor of three QoL domains (physical, psychological, and environment). Meaning in life made a unique contribution to the social QoL regression model, and it was also a significant predictor of psychological QoL. Body acceptance by others was a significant predictor of physical QoL, whereas disease duration and education predicted environment QoL. Attachment styles did not predict any QoL domain. CONCLUSION: The most significant predictors of QoL in patients with IBD were body appreciation and meaning in life. Body acceptance by others and body appreciation were the main predictors of physical QoL. Psychological interventions for patients who suffer from IBD should address body appreciation and meaning in life

PCV141 Atherosclerosis : real-world insights from a Portuguese primary care database

Copyright © 2019 Published by Elsevier Inc.Objectives: Cardiovascular disease remains the leading cause of death in Portugal and across the world. Atherosclerosis is the most common pathophysiologic process underlying CVD. Its clinical manifestations include coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral artery disease (PAD). This study aims to determine the clinical and demographic characteristics of adult patients with atherosclerosis in a Portuguese primary care comprehensive administrative database.info:eu-repo/semantics/publishedVersio

The cost and burden of schizophrenia in Portugal in 2015

© 2017 Gouveia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedIntrodução: A esquizofrenia é uma importante causa de incapacidade e consumo de recursos económicos. Neste estudo pretendemos estimar os custos e a carga da esquizofrenia para 2015 em Portugal Continental. Métodos: A carga da doença foi medida pelos anos de vida ajustados pela incapacidade (DALY- Disability-adjusted life years), uma métrica adotada pela Organização Mundial de Saúde. O custo da doença foi estimado com base na prevalência adotando a perspetiva global da sociedade. Os custos incluíram os consumos de recursos e os custos indiretos dos doentes e cuidadores (perdas de produtividade). As principais fontes de informação de custos foram: a base de dados GDH; os contratos programa; dados de consumo de medicamentos e opinião de peritos. Resultados: A prevalência da esquizofrenia será cerca de 48 mil doentes, sendo que o número de doentes seguidos pelo sistema de saúde (público e privado) deverá estar na ordem dos 41 mil doentes. Em 2015, estima-se que se tenham perdido 28.588 DALY (84% por incapacidade; 16% por mortalidade prematura). A preços de 2015, o total estimado de custos diretos e indiretos da esquizofrenia foi respetivamente de € 96,1 e € 340,3 milhões (97% gerados pelos doentes). Conclusão: A esquizofrenia tem um importante impacto social em Portugal devido essencialmente à morbilidade gerada, podendo-se-lhe atribuir em 2015 um custo total de € 436,3 milhões, cerca de 0,24% do produto interno bruto. Os custos diretos representam 0,6 % de todas as despesas de saúde em 2015, enquanto a totalidade dos custos (diretos e indiretos) representam 2,7% da despesa em saúde.info:eu-repo/semantics/publishedVersio

A aterosclerose nos cuidados de saúde primários: estudo da vida real

Introduction and Objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.Introdução e objetivos: caracterizar os doentes com aterosclerose, uma doença com elevado impacto socioeconómico, na Região de Saúde de Lisboa e Vale do Tejo. Métodos: Estudo observacional transversal, recorrendo ao Sistema de Informação desta Administração Regional de Saúde, com extração de dados clínico-demográficos e de consumo de recursos dos utilizadores adultos com aterosclerose em 2016. A aterosclerose foi definida pela presença de manifestações clínicas, fatores de risco aterotrombóticos e/ou consumo de medicamentos marcadores de aterosclerose. Foram comparados os resultados para a população com e sem manifestações clínicas (testes paramétricos). Resultados: Identificámos 318 692 utilizadores, a maioria (n=224 845 doentes; 71%) sem registo de manifestações clínicas. A subpopulação com manifestações clínicas era mais idosa (72,0±11,5 versus 71,3±11,0 anos), com maior proporção de homens (58,0% versus 45,9%), registo de hipertensão arterial (78,3% versus 73,5%), dislipidemia (55,8% versus 53,5%) e menor proporção de registo de obesidade (18,2% versus 20,8%), em comparação com a população sem manifestações clínicas (p<0,001). Os valores médios de pressão arterial sistólica/diastólica, C-C-LDL e hemoglobina glicada foram inferiores na subpopulação com manifestações (142/74 versus 146/76 mmHg, 101 versus 108 mg/dL, 6,80 versus 6,84%, respetivamente; p<0,001). Cada utilizador com aterosclerose realizou 4,1±2,9 consultas médicas presenciais e 8,6±10,0 painéis de análises clínicas, com diferenças nas subpopulações com e sem manifestações clínicas (4,4 ± 3,2 versus 4,0 ± 2,8 e 8,3 ± 10,3 versus 8,7±9,8, respetivamente; p<0,001). Conclusões: Cerca de um em cada três utilizadores adultos de cuidados de saúde primários com aterosclerose têm manifestações clínicas. Os resultados sugerem que o controlo dos factores de risco cardiovascular é sub-óptimo em doentes com aterosclerose.info:eu-repo/semantics/acceptedVersio