Is sirolimus a therapeutic option for patients with progressive pulmonary lymphangioleiomyomatosis?

<p>Abstract</p> <p>Background</p> <p>Lymphangioleiomyomatosis (LAM) is a rare lung disease characterised by progressive airflow obstruction. No effective medical treatment is available but therapy with sirolimus has shown some promise. The aim of this observational study was to evaluate sirolimus in progressive LAM.</p> <p>Methods</p> <p>Sirolimus (trough level 5 - 10 ng/ml) was administered to ten female patients (42.4 ± 11.9 years) with documented progression. Serial pulmonary function tests and six-minute-walk-distance (6-MWD) assessments were performed.</p> <p>Results</p> <p>The mean loss of FEV₁was -2.30 ± 0.52 ml/day before therapy and a significant mean gain of FEV₁of 1.19 ± 0.26 ml/day was detected during treatment (p = 0.001). Mean FEV₁and FVC at baseline were 1.12 ± 0.15 l (36.1 ± 4.5%pred.) and 2.47 ± 0.25 l (69.2 ± 6.5%pred.), respectively. At three and six months during follow-up a significant increase of FEV₁and FVC was demonstrated (3 months ΔFEV₁: 220 ± 82 ml, p = 0.024; 6 months ΔFEV₁: 345 ± 58 ml, p = 0.001); (3 months ΔFVC: 360 ± 141 ml, p = 0.031; 6 months ΔFVC: 488 ± 138 ml, p = 0.006). Sirolimus was discontinued in 3 patients because of serious recurrent lower respiratory tract infection or sirolimus-induced pneumonitis. No deaths and no pneumothoraces occurred during therapy.</p> <p>Conclusions</p> <p>Our data suggest that sirolimus might be considered as a therapeutic option in rapidly declining LAM patients. However, sirolimus administration may be associated with severe respiratory adverse events requiring treatment cessation in some patients. Moreover, discontinuation of sirolimus is mandatory prior to lung transplantation.</p

Academic and life satisfaction in Portuguese and Mozambican college students : a comparative study

Publicado em "ICERI2010 Proceedings, ISBN 978-84-614-2439-9"The social-cognitive model of well-being [1] has become an important framework to study satisfaction and adjustment in specific life contexts and in overall life [1] [2]. Taking into consideration this integrative perspective, this paper aims to understand and compare the process of academic satisfaction in European and Mozambican Portuguese speaking college students, and to draw implications for psycho educational interventions and research in those contexts. We present and discuss the results of the assessment of self-efficacy, goal progress, environmental supports, academic adjustment, positive affect and overall life satisfaction dimensions (AAQ; Academic Adjustment Questionnaire [1]), conducted with 305 students attending one public university and one public polytechnic institute in Portugal, and with 465 students attending one public university in Mozambique. A first study of the instrument in Portugal with higher education students [3] revealed values of internal consistency for the seven scales ranging between 0,75 and 0,88 (M =0, 84, SD = 5,00). In this study, the range of internal consistency coefficients (Cronbach alpha) were between 0,52 and 0,78 (M =0,67, SD = 9,5) for the Portuguese sample, and between 0,65 and 0,83 (M =0,75, SD = 5,4) for the African Mozambican sample. Moreover, in the Portuguese sample, positive correlations were registered between the dimensions of academic adjustment, positive affect and satisfaction with life in general. In the Mozambican sample, in turn, in general, moderate and positive correlations were obtained, statistically significant between all the dimensions of the academic adjustment that were evaluated. An analysis of the mean tells us that, in both samples, students tend to have moderate values on the dimensions of the academic adjustment model. The comparison test of means reveals significant differences between the two countries in the overall dimensions of academic adjustment, with the exception of the scale factors to stimulate the academic adjustment. Specifically, the Portuguese students obtain the highest values in the dimensions of self-confidence, overall adjustment, and satisfaction with life. The Mozambican students registered higher results on self- confidence to face academic barriers and progress in their academic goals. The results obtained also evidence that students from both countries perceive they have a support system and incentives in the academic and classroom environments. This is a dimension that is directly and indirectly correlated with academic adjustment, in both samples, which suggests the importance of socio-cognitive dimensions of adjustment to college

Evaluation of an in-house molecular HIV-1 test to assess mother-to-child HIV-1 transmission in Angola (the APEHC cohort)

Poster presented at the 17th Annual International Meeting of the Institute of Human Virology. Baltimore, 27-30 September 2015"Mother-to-child-transmission (MTCT) rate has decreased sharply in recent years in most of the sub-Saharan Africa, however 220,000 children acquired HIV-1 in 2014. PCR detection of proviral DNA is the most sensitive method for early infant diagnosis (EID) of HIV-1 infection. Commercial kits are available but they have poor sensitivity with divergent non-B subtypes and high costs (≈30€ per test) which limit their use in resource-limited settings. The HIV-1 epidemic in Angola is driven by highly divergent strains of all group M subtypes, except B, as well as multiple recombinant forms (CRFs and URFs) making EID a challenge in this setting. The aim of this study was to develop and validate a qualitative, inexpensive and sensitive “inhouse” HIV-1 EID assay on heel prick dried blood spots (DBS) from infants of the Hospital da Divina Providência (HDP) in Luanda, Angola and determine the current HIV-1 MTCT rate in the Angolan PErinatal HIV Cohort (APEHC)."Fundação para a Ciência e a Tecnologia - Portugal ; European Unio

Dilemmas of girls and women in engineering: a study in Portugal

The reason that girls and women withdraw from science and technology education and careers has been a universal concern in the social sciences. This study investigated how gendered constructions of identity are translated into the barriers and fears that female students and professional women experience in decision-making about their careers. We conducted interviews with 63 girls and 39 women in academic and professional engineering careers, focusing on their interpersonal relationships with boys and men in their school and occupational engineering settings, respectively. Participant discourse highlighted the difficulties women face when managing the antagonistic discourses of femininity and masculinity in a social environment in which they are frequently forced to submit to hegemonic masculinity. The consequences of women’s differing discourses about the “masculine world” and the “feminine world” are discussed, and some strategies for creating more equalitarian relational environments in school and work settings are discussed.Fundação para a Ciência e a Tecnologia (FCT

Medicines review in the elderly

Poster presented at the Pharmaceutical Care Network Europe (PCNE) Working Symposium: Medication review, Drug-related problems, Standards and Guidelines, 2014, Sliema (Malta)Egas Moniz - Cooperativa de Ensino Superior CRL; Ordem dos Farmacêuticos

Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies

Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.info:eu-repo/semantics/publishedVersio

Exploración vocacional en adolescentes: evaluación de una intervención en clase

Analisa-se o impacto de uma intervenção psicológica na exploração e tomada de decisão vocacional em adolescentes portugueses. Em contexto curricular e de classe, desenvolveram-se actividades de exploração do meio e do Eu com 39 alunos e 43 alunas do 9o ano, entre 13 e 17 anos (M=14,4, DP=0,95). Em um design pré/pós-teste, aplicaram-se o Career Exploration Survey (CES) e o Career Decision Difficulties Questionnaire (CDDQ). Os resultados do teste do sinal evidenciaram ganhos significativos (p<0,01) nas dimensões de exploração e diminuição significativa da falta de informação profissional (p<0,01) e do total das dificuldades de decisão (p<0,05). Observou-se um padrão de correlações negativas (ró de Spearman) entre as duas medidas vocacionais, evidenciando uma relação entre a informação explorada na intervenção e a diminuição das dificuldades de decisão por falta de motivação. Em geral, os resultados suportam a importância do papel da exploração da carreira na diminuição das dificuldades de tomada de decisão.This study analyses the impact of a psychological intervention to promote vocational exploration and decisionmaking in Portuguese adolescents. Activities to foster exploration of self and environment were developed in a classroom program with 39 boys and 43 girls, all 9th grade students, between 13 and 17 years of age (M=14,4, SD=0.95). Following a pre/post-test design, the Career Exploration Survey (CES), and the Career Decision Difficulties Questionnaire (CDDQ) were administered. Results of sign-test showed significant increments (p<0.01) in all of the exploration dimensions, significant reduction of lack of occupational information (p<0.01) and of the total of career decision-making difficulties (p<0.05). Negative correlations (Spearman’s rho) between the two career measures was observed, evidencing a relationship between information explored during intervention and decreased difficulty with decision-making due to lack of motivation. In general, results support the importance of career exploration on diminishing decision-making difficulties.Evalúa-se el impacto de una intervención psicológica que fomenta la exploración y la decisión vocacional en adolescentes portugueses. Fueran efectuadas actividades de exploración del medio ambiente y del yo en contexto curricular de clase con 39 alumnos y 43 alumnas del curso 3º ESO, 13 hasta 17 años (M=14,4, DP=0,95). Utilizó-se un diseño pre/posteste, con aplicación del Career Exploration Survey (CES) y Career Decision Difficulties Questionnaire (CDDQ). Resultados del test del señal evidencian beneficios significativos (p<0,01) en las dimensiones de la exploración, reducción significativa de ausencia de información ocupacional (p<0,01) y total de dificultades de decisión (p<0,05). Ha sido observado un patrón de correlaciones negativas (ró de Spearman) entre las dos medidas vocacionales, mostrando relación entre la información explorada e la disminución de las dificultades de decisión por falta de motivación. En general, resultados sostienen la importancia de la exploración de carrera en la disminución de las dificultades de decisió

Epidemic history of hepatitis C virus genotypes and subtypes in Portugal

Any successful strategy to prevent and control HCV infection requires an understanding of the epidemic behaviour among the different genotypes. Here, we performed the first characterization of the epidemic history and transmission dynamics of HCV subtypes in Portugal. Direct sequencing of NS5B was performed on 230 direct-acting antiviral drugs (DAA)-treatment naïve patients in Lisbon. Phylogenetic analysis was used for subtyping and transmission cluster identification. Bayesian methods were used to reconstruct the epidemic history of HCV subtypes. Sequences were analysed for resistance-associated substitutions (RAS). The majority of strains were HCV-GT1 (62.6%), GT3 (18.3%, all subtype 3a) and GT4 (16.1%). Among GT1, the most frequent were subtypes 1a (75.5%) and 1b (24.5%). Polyphyletic patterns were found in all but 12 lineages suggesting multiple introductions of the different subtypes in this population. Five distinct epidemics were identified. The first significant HCV epidemic in Portugal occurred between 1930s and 1960s, was caused almost exclusively by GT1b and was likely associated with blood transfusions. Rapid expansion of GT3a occurred in the 1960s and GT1a in the 1980s, associated with intravenous drug use. The most recent epidemics were caused by GT4a and GT4d and seem to be associated with the resurgence of opioid use. The C316N substitution was found in 31.4% of GT1b-patients. Close surveillance of patients bearing this mutation and undergoing dasabuvir-based regimens will be important to determine its impact on treatment outcome.publishersversionpublishe