Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies

BACKGROUND: Primary Human Papilloma Virus (HPV) testing is the currently recommended cervical cancer (CxCa) screening strategy by the Portuguese Society of Gynecology (SPG) clinical consensus. However, primary HPV testing has not yet been adopted by the Portuguese organized screening programs. This modelling study compares clinical benefits and costs of replacing the current practice, namely cytology with ASCUS HPV triage, with 2 comparative strategies: 1) HPV (pooled) test with cytology triage, or 2) HPV test with 16/18 genotyping and cytology triage, in organized CxCa screenings in Portugal. METHODS: A budget impact model compares screening performance, clinical outcomes and budget impact of the 3 screening strategies. A hypothetical cohort of 2,078,039 Portuguese women aged 25-64 years old women is followed for two screening cycles. Screening intervals are 3 years for cytology and 5 years for the HPV strategies. Model inputs include epidemiological, test performance and medical cost data. Clinical impacts are assessed with the numbers of CIN2-3 and CxCa detected. Annual costs, budget impact and cost of detecting one CIN2+ were calculated from a public healthcare payer's perspective. RESULTS: HPV testing with HPV16/18 genotyping and cytology triage (comparator 2) shows the best clinical outcomes at the same cost as comparator 1 and is the most cost-effective CxCa screening strategy in the Portuguese context. Compared to screening with cytology, it would reduce annual CxCa incidence from 9.3 to 5.3 per 100,000, and CxCa mortality from 2.7 to 1.1 per 100,000. Further, it generates substantial cost savings by reducing the annual costs by €9.16 million (- 24%). The cost of detecting CIN2+ decreases from the current €15,845 to €12,795. On the other hand, HPV (pooled) test with cytology triage (comparator 1) reduces annual incidence of CxCa to 6.9 per 100,000 and CxCa mortality to 1.6 per 100,000, with a cost of €13,227 per CIN2+ detected with annual savings of €9.36 million (- 24%). The savings are mainly caused by increasing the length of routine screening intervals from three to five years. CONCLUSION: The results support current clinical recommendations to replace cytology with HPV with 16/18 genotyping with cytology triage as screening algorithm.info:eu-repo/semantics/publishedVersio

A community-based study of stroke code users in northern Portugal

Introdução: Em 2002 Portugal detinha uma das mais altas taxas de mortalidade por doenças cerebrovasculares entre os países europeus. Várias estratégias foram adoptadas para melhorar a prevenção da doença e o seu tratamento na fase aguda, entre as quais a criação da Via Verde do Acidente Vascular Cerebral. O objectivo deste trabalho é descrever a utilização e resultados desta estratégia no contexto de um registo prospectivo comunitário na Região Norte de Portugal. Material e Métodos: Foram registados todos os AVCs ocorridos entre 1 de Outubro de 2009 e 30 de Setembro de 2010 nos utentes inscritos no agrupamento de centros de saúde do Porto Ocidental e nos de Mirandela e Vila Pouca de Aguiar. Para a detecção de casos utilizaram-se múltiplas fontes de informação: notificação via WEB, e-mail, Alerta P1 e pesquisas sistemáticas em registos disponibilizados pelas entidades envolvidas - urgências hospitalares, listas de altas, procedimentos de diagnóstico, óbitos, Via Verde do Acidente Vascular Cerebral e serviço de atendimento de situações urgentes. Resultados: Ocorreram 600 AVCs em 241 000 habitantes (taxa de incidência de 250 / 100 000), dos quais 434 foram primeiros na vida (180 / 100 000). Foram registados 72 acessos à Via Verde do Acidente Vascular Cerebral, dos quais 66,7% foram diagnosticados como AVC. Considerando os quatro critérios de activação (idade ≤ 80 anos, independência funcional, sinais/sintomas do AVC e tempo após episódio ≤ 3 horas), só 15,9% dos doentes a poderiam utilizar e, dos utilizadores, apenas 56,3% satisfaziam esses critérios. Dos doentes com critérios de activação, foram internados 96,3% pela VV pré-hospitalar, 83,3% pela VV intra/inter-hospitalar e 64,0% dos restantes; a fibrinólise foi realizada em 77,3%, 36,4% e 17,4% dos doentes com enfarte cerebral, respectivamente. O Rankin pós- AVC é mais grave nos utilizadores da VV pré-hospitalar (70,3% vs. 35,3%), mas estes apresentam mais assiduamente os três sinais/ sintomas de AVC (44,4% vs. 16,2%). Ajustando para a idade, sexo e número de sinais, o risco de incapacidade grave pós-AVC não é significativamente diferente no acesso pela VV pré-hospitalar (RP = 2,9; IC 95%: 0,8 - 10,2), bem como a taxa de letalidade. Conclusões: Os critérios para activação da Via Verde do Acidente Vascular Cerebral são muito restritivos. Embora esta seja mais vezes accionada em situações clínicas graves, a proporção de doentes que realizou fibrinólise é relativamente alta em comparação com outros estudos.A informação usada neste artigo é parte integrante do Projecto PIC/IC/82858/2007 financiado pela Fundação para a Ciência e a Tecnologi

The knowledge domain of affective computing: a scientometric review

Purpose – The aim of this study is to investigate the bibliographical information about Affective Computing identifying advances, trends, major papers, connections, and areas of research. Design/methodology/approach – A scientometric analysis was applied using CiteSpace, of 5,078 references about Affective Computing imported from the Web-of-Science Core Collection, covering the period of 1991-2016. Findings – The most cited, creative, burts and central references are displayed by areas of research, using metrics and througout-time visualization. Research limitations/implications – Interpretation is limited to references retrieved from theWeb-of-Science Core Collection in the fields of management, psychology and marketing. Nevertheless, the richness of bibliographical data obtained, largely compensates this limitation. Practical implications – The study provides managers with a sound body of knowledge on Affective Computing, with which they can capture general public emotion in respect of their products and services, and on which they can base their marketing intelligence gathering, and strategic planning. Originality/value – The paper provides new opportunities for companies to enhance their capabilities in terms of customer relationships.info:eu-repo/semantics/acceptedVersio

Structural and functional stabilization of glycomacropeptide via encapsulation within multiple emulsions

Bovine glycomacropeptide (GMP), derived from whey proteins, has been demonstrated to possess an interesting bioactivity that has attracted a lot of attention over the last few years. In particular, its ability to bind Vibrio cholerae and Escherichia coli enterotoxins, inhibit bacterial and viral adhesion, suppress gastric secretions, promote bifidobacterial growth and modulate immune system responses. Of these, protection against toxins, bacteria and viruses, and modulation of the immune system, are the most promising applications for this bioactive dairy macropeptide. The development of strategies that may allow its structural and functional stabilization via nanoencapsulation within multiple emulsions may increase its food and biopharmaceutical applicabilities. In this research effort, bovine GMP was (thermodynamically) stabilized via entrapment within water-in-oil-in-water (W/O/W) multiple emulsions aiming at mimicking the multifunctional design of biology, with several lipid matrices, and stabilizing layer compositions. Due to their compartimentalized internal structure, multiple emulsions are ideal for encapsulation since they can carry both polar and non-polar (bio)molecules. The composition of the stabilizing layer of the nanosystem was changed by using different poloxamers and proportions of lecithin. Physicochemical characterization of the optimized GMP-encasing nanovesicle formulations encompassed determination of Zeta potential and particle hydrodynamic size over storage time, surface morphology via CRYO-SEM, and microcalorimetric analysis via DSC

The effect of emotions on brand recall by gender using voice emotion response with optimal data analysis

Purpose—To analyses the effect of emotions obtained by oral reproduction of advertising slogans established via Voice Emotion Response software on brand recall by gender; and to show the relevance for marketing communication of combining “human–computer Interaction (HCI)” with “affective computing (AC)” as part of their mission. Design/methodology/approach—A qualitative data analysis did the review of the scientific literature retrieved from Web-of-Science Core Collection (WoSCC), using CiteSpace’ scientometric technique; the quantitative data analysis did the analysis of brand recall over a sample of Taiwan’ participants by “optimal data analysis”. Findings—Advertising effectiveness has a positive association with emotions; brand recall varies with gender; and “HCI” connected with “AC” is an emerging area of research. Research limitations/implications—The selection of articles obtained depend on the terms used in WoSCC, and this study used only five emotions. Still the richness of the data gives some compensation. Practical implications—Marketers involved with brands need a body of knowledge on which to base their marketing communication intelligence gathering and strategic planning. Originality/value—It provides exploratory research findings related to the use of automatic tools capable of mining emotions by gender in real time, which could enhance the feedback of customers toward their brands.info:eu-repo/semantics/acceptedVersio

Continuous dynamic monitoring of bridges: different perspectives of application

This paper makes a brief characterisation of some aspects related with the extensive research activity of the Laboratory of Vibrations and Structural Monitoring (ViBest) of the Faculty of Engineering of the University of Porto (FEUP) in the field of Continuous Dynamic Monitoring of Bridges and Special Structures, selecting four examples where large high quality databases have been created since 2007, namely Infante D. Henrique bridge, Pedro e Ines footbride, FEUP Campus stress-ribbon footbridge and Trezoi railway bridge

Controlling parenting and executive functioning in children born preterm

This study investigated the relations between mothers’ and fathers’ controlling behaviors and the executive functioning of children born preterm. Sixty-eight preterm children and their parents were assessed when the children were 3 ½ years old. The executive functioning was measured using the Headto-Toes-Task and controlling parenting behaviors were measured through a standardized observation of a parent-child interaction. Hierarchical regression analysis showed that both mothers’ and fathers’ controlling behaviors were associated with worse child executive functioning performance, after controlling for the child’s cognitive ability. Findings suggest that both mothers and fathers play an important role in the development of executive functioning of children born prematurely, highlighting the need to consider both parents in the study of and intervention with these children.info:eu-repo/semantics/publishedVersio