The split-plot design was useful for evaluating complex, multi-level interventions but there is need for improvement in its design and report

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Novas perspetivas da neuroplasticidade induzida por ECT no tratamento da depressão

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021A patologia depressiva afeta hoje em dia mais de 264 milhões de pessoas de todas as idades mundialmente, sendo responsável por alterações da estrutura de inúmeras áreas cerebrais e mecanismos fisiológicos. Uma das terapias mais eficazes no seu tratamento, a Terapia Electroconvulsiva (ECT), apresenta-se ainda com uma fraca compreensão dos seus mecanismos de ação. Este trabalho faz uma revisão narrativa da literatura disponibilizada, em anos recentes, de estudos conduzidos em animais e humanos sobre os efeitos da ECT na estrutura cerebral e nos fatores neurotróficos. Foram encontradas evidências de que há um aumento do volume de várias estruturas, com maior indícios da alteração do hipocampo humano e que em modelos animais existe uma alteração da neuroplastia cerebral (neurogénese, sinaptogénese, angiogénese e gliogénese). Foram também encontradas evidências de um aumento da concentração de Fator Neurotrófico Derivado do Cérebro (BDNF) e outros fatores neurotróficos. Apesar destas evidências a ligação entre estas alterações e as melhorias clínicas é ainda incerta. Futuros estudos devem demonstrar a ligação entre as alterações macroscópicas e o aumento da proliferação celular em humanos, e a relação destas com os resultados clínicos.Depression affects today more than 264 million people of all ages worldwide and it is responsible for modifications of several brain areas and physiological mechanisms. ECT is one of the most effective therapies for major depressive disorder, yet its mechanism of action remains poorly understood. This work reviews the recent available animal and human literature about the effects of ECT in the brain structure and neurotrophic factors. Human studies suggest that there is a volume increase in several brain structures, with more evidence on the hippocampal volume change and animal studies indicate that ECT alters the subject’s neuroplasticity (neurogenesis, synaptogenesis, angiogenesis and gliogenesis). Evidence also shows an increase in the Brain-Derived Neurotrophic Factor (BDNF) and other neurotrophic factors in the organism of both animal and human subjects. Still, it remains unclear whether these changes might explain the therapeutic efficacy. Future studies should demonstrate the connection between the structural changes and the increase in cell proliferation in humans and the link with the clinical results

Seleção de variáveis na presença de valores omissos: uma aplicação na modelação do índice de massa corporal nos imigrantes africanos e brasileiros

Tese de mestrado em Bioestatística, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, 2013Os dados omissos são muito comuns em estudos clínicos e epidemiológicos. Os métodos usados por diversos programas estatísticos para tratar este tipo de problema (por exemplo, a rejeição total dos registos com observações omissas nalguma das variáveis – análise dos casos completos (CC)) nem sempre são satisfatórios. De facto, se os indivíduos com valores omissos diferirem significativamente dos com valores observados, então, não considerar os dados incompletos, poderá enviesar os resultados do estudo. Existem diversas técnicas para tratar dados omissos, nomeadamente a substituição dos valores omissos por valores considerados plausíveis, por um único valor (imputação simples) ou por vários (imputação múltipla). Esta investigação pretende avaliar o impacto de diferentes técnicas para tratamento de valores omissos na escolha de variáveis em modelos de regressão, cuja variável resposta é o índice de massa corporal (IMC). A amostra é formada por 1980 imigrantes brasileiros e africanos a viver em Portugal. Os dados foram recolhidos no âmbito do estudo de Saúde dos imigrantes, realizado em 2007. Elaboraram-se três cenários de dados omissos: 1) cenário real, com tratamento da variável com maior percentagem de dados omissos – escolaridade (6.8%); 2) simulação da existência de 20% de dados omissos na mesma variável; 3) simulação da existência de 20% de dados omissos na variável idade que está fortemente associada ao IMC. A análise CC e as técnicas de imputação conduziram a resultados semelhantes no primeiro cenário. Nos cenários 2 e 3, as técnicas de imputação revelaram-se superiores à análise CC. Os resultados deste trabalho sugerem que a existência de uma baixa percentagem de dados omissos, numa variável explicativa pouco associada com a variável resposta, parece ter poucas implicações nos resultados finais, independentemente da técnica escolhida para lidar com os dados omissos. No caso de percentagens elevadas de dados omissos, a análise CC é claramente inferior às técnicas de imputação.Missing data is a common problem in epidemiological and clinical studies. The methods used to handle this problem are often unsatisfactory, namely disregarding all the subjects with missing values in any of the variables used (complete case analysis). In fact, if subjects with missing data differ significantly from the remaining subjects in the sample, then using CC analysis can produce erroneous results. There are several techniques to handle missing data, including the replacement of these observations with one (simple imputation) or several (multiple imputation) plausible values. This research intends to assess the impact of different techniques to handle missing data in the selection of variables in a regression model, in which the body mass index (BMI) is the dependent variable. The sample is constituted by 1980 Brazilian and African immigrants, living in Portugal. The data were collected in 2007, as part of an Immigrants’ Health study. Three scenarios of missing data were examined: 1) the real scenario, in which the variable with the highest percentage of missing data was considered (education, 6.8%); 2) simulation of 20% of missing data in the same variable; 3) simulation of 20% of missing data in the variable age, which is strongly associated with BMI. The CC analysis and the imputation techniques produced similar results in the 1st scenario. In the 2nd and 3rd scenarios, imputation techniques performed better than the CC approach. The results obtained suggest that the existence of a small percentage of missing data, in a variable poorly associated with the main outcome, seems to have little impact in final results, no matter which technique for handling missing data is used. If the percentage of missing data is high, CC analysis is clearly inferior when compared with the imputation techniques

Development of a root caries prediction model in a population of dental attenders

Acknowledgement This study was conducted as part of the doctoral thesis of P.A.F. We would like to thank the participating dental practice teams and patients without whose valuable contribution this study could not have taken place. We would like to thank our colleagues in the INTERVAL Trial team Funding INTERVAL was funded by the NIHR HTA programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)]. No additional funding was obtained to conduct the prediction study presented in this paper. The views expressed are those of the author(s) and not necessarily those of NIHR, the NHS or the Department of Health and Social Care.Peer reviewedPublisher PD

Development of a Root Caries Prediction Model in a Population of Dental Attenders

Acknowledgement This study was conducted as part of the doctoral thesis of P.A.F. We would like to thank the participating dental practice teams and patients without whose valuable contribution this study could not have taken place. We would like to thank our colleagues in the INTERVAL Trial team Funding INTERVAL was funded by the NIHR HTA programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)]. No additional funding was obtained to conduct the prediction study presented in this paper. The views expressed are those of the author(s) and not necessarily those of NIHR, the NHS or the Department of Health and Social Care.Peer reviewedPublisher PD

National survey of the Portuguese elderly nutritional status : study protocol

Acknowledgements We acknowledge the IAN-AF team (in particular to Duarte Torres, Milton Severo and Andreia Oliveira) for the community sampling and their support on dietary assessment methodology and critical discussion along the elaboration of the present protocol. Funding This project (136SI5) was granted by the Public Health Initiatives Programme (PT06), financed by EEA Grants Financial Mechanism 2009-2014.Peer reviewedPublisher PD

Starting a conversation about estimands with public partners involved in clinical trials: a co-developed tool

BACKGROUND: Clinical trials aim to draw conclusions about the effects of treatments, but a trial can address many different potential questions. For example, does the treatment work well for patients who take it as prescribed? Or does it work regardless of whether patients take it exactly as prescribed? Since different questions can lead to different conclusions on treatment benefit, it is important to clearly understand what treatment effect a trial aims to investigate-this is called the 'estimand'. Using estimands helps to ensure trials are designed and analysed to answer the questions of interest to different stakeholders, including patients and public. However, there is uncertainty about whether patients and public would like to be involved in defining estimands and how to do so. Public partners are patients and/or members of the public who are part of, or advise, the research team. We aimed to (i) co-develop a tool with public partners that helps explain what an estimand is and (ii) explore public partner's perspectives on the importance of discussing estimands during trial design. METHODS: An online consultation meeting was held with 5 public partners of mixed age, gender and ethnicities, from various regions of the UK. Public partner opinions were collected and a practical tool describing estimands, drafted before the meeting by the research team, was developed. Afterwards, the tool was refined, and additional feedback sought via email. RESULTS: Public partners want to be involved in estimand discussions. They found an introductory tool, to be presented and described to them by a researcher, helpful for starting a discussion about estimands in a trial design context. They recommended storytelling, analogies and visual aids within the tool. Four topics related to public partners' involvement in defining estimands were identified: (i) the importance of addressing questions that are relevant to patients and public in trials, (ii) involving public partners early on, (iii) a need for education and communication for all stakeholders and (iv) public partners and researchers working together. CONCLUSIONS: We co-developed a tool for researchers and public partners to use to facilitate the involvement of public partners in estimand discussions

Prevalência de excesso de peso nos imigrantes brasileiros e africanos residentes em Portugal

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Occurrence of antibiotics, antibiotic resistance genes and viral genomes in wastewater effluents and their treatment by a pilot scale nanofiltration unit

Funding Information: Funding: This research was funded by Fundação para a Ciência e a Tecnologia through the project PTDC/CTA-AMB/29586/2017. We also acknowledge the financial support from Fundação para a Ciência e Tecnologia and Portugal 2020 to the Portuguese Mass Spectrometry Network (LISBOA-01-0145-FEDER-402-022125). iNOVA4Health-UIDB/04462/2020, a program financially supported by Fundação para a Ciência e Tecnologia/Ministério da Educação e Ciência, through national funds, is gratefully acknowledged. Associate Laboratory for Green Chemistry-LAQV, which is financed by national funds from FCT/MCTES (UID/QUI/50006/2019), is gratefully acknowledged. Funding from INTERFACE Program, through the Innovation, Technology and Circular Economy Fund (FITEC), is gratefully acknowledged. Funding Information: This research was funded by Funda??o para a Ci?ncia e a Tecnologia through the project PTDC/CTA-AMB/29586/2017. We also acknowledge the financial support from Funda??o para a Ci?ncia e Tecnologia and Portugal 2020 to the Portuguese Mass Spectrometry Network (LISBOA-01-0145-FEDER-402-022125). iNOVA4Health-UIDB/04462/2020, a program financially supported by Funda??o para a Ci?ncia e Tecnologia/Minist?rio da Educa??o e Ci?ncia, through national funds, is gratefully acknowledged. Associate Laboratory for Green Chemistry-LAQV, which is financed by national funds from FCT/MCTES (UID/QUI/50006/2019), is gratefully acknowledged. Funding from INTERFACE Program, through the Innovation, Technology and Circular Economy Fund (FITEC), is gratefully acknowledged. Publisher Copyright: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.Broad-spectrum fluoroquinolone antibiotics (ciprofloxacin and levofloxacin), carbapenem and fluoroquinolone resistance genes, as well as viral genomes, were detected in grab samples of wastewater effluents. Passive samplers, which are simpler and easier to use and provide information about the concentrations and combination of contaminants present in a certain fluid matrix over time, proved to be extremely promising devices to monitor the presence of the target antibiotics in wastewater effluents. Nanofiltration was tested with a pilot-scale unit installed at a domestic wastewater treatment facility, using a Desal 5DK membrane operated at a constant transmembrane pressure of 6 bar and 70% recovery rate. In a 24 h experimental assay, the variation of the membrane permeance was low (6.3%). High rejections of the target contaminants from the wastewater effluent were obtained by the pilot-scale treatment. Hence, nanofiltration using the Desal 5DK membrane is considered to be a promising treatment to cope with chemical and biological contaminants present in wastewater effluents.publishersversionpublishe

Malnutrition among older adults living in Portuguese nursing homes : the PEN-3S study

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