SIDA à data do diagnóstico de infeção por VIH e por evolução de estádio (2009-2018): características dos casos notificados.

Introdução: A utilização de fármacos antirretrovirais altamente eficazes no controlo da infeção por VIH levou à redução da incidência de SIDA em Portugal, contudo esta mantém-se das mais elevadas da União Europeia. Objetivo: Comparar as características dos casos de SIDA concomitantes com o diagnóstico de infeção por VIH, com aqueles resultantes de evolução de estádio (diagnósticos diferidos), na última década. Métodos: Estudo retrospetivo dos casos de SIDA registados na base de dados nacional de vigilância epidemiológica, com diagnóstico de estádio entre 2009 e 2018. Efetuou-se a análise descritiva das características dos casos de acordo com o momento do diagnóstico (concomitante com VIH vs diferido), utilizando o software Epi Info™ (versão 7.2.2.6). Resultados: (ver ficheiro anexo) Conclusão: A maioria dos diagnósticos concomitantes ocorreu em homens heterossexuais reforçando a necessidade de aumentar o diagnóstico precoce neste grupo. A proporção de UDI nos casos com evolução poderá refletir a elevada incidência de VIH neste grupo no passado e uma maior dificuldade de adesão aos cuidados de saúde.info:eu-repo/semantics/publishedVersio

An application of extreme value theory in medical sciences

Tese de mestrado em Bioestatística, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, em 2018Valores altos de pressão arterial são considerados um fator de risco de doenças cardiovasculares, ver [Hajar, 2016]. Estas doenças são a principal causa de morte em Portugal. Com o objectivo de criar um perfil da população Portuguesa em relação aos riscos de doenças cardiovasculares, um estudo foi desenvolvido em 2005, pela Associação Nacional de Farmácias através do seu Departamento de Serviços Farmacêuticos. O interesse principal do presente estudo consiste em modelar valores elevados de pressão arterial sistólica em indivíduos que sofrem de uma categoria particular de hipertensão. Um estudo similar foi desenvolvido para modelar os valores elevados de níveis de colesterol total, ver [de Zea Bermudez and Mendes, 2012]. A presente dissertação tem dois principais interesses: estudar a distribuição geográfica dos valores elevados de pressão arterial sistólica (em indivíduos com valores normais de pressão arterial diastólica) em Portugal, i.e., ajustar modelos de valores extremos para cada distrito de Portugal e ilhas e analisar em particular o grupo de maior risco, i.e., indivíduos idosos. Com esse propósito, a metodologia Peaks Over Threshold foi aplicada. Esta metodologia consiste em ajustar um modelo aos excessos (ou excedências) acima de um limiar de pressão arterial sistólica suficientemente elevado. Os modelos obtidos serão capazes de estimar quantis elevados e probabilidades de cauda de pressão arterial sistólica. Na presente dissertação, os indivíduos foram divididos em quatro grupos distintos. Aqueles que apresentavam valores normais de pressão arterial sistólica e pressão arterial diastólica. Os que apresentavam valores superiores aos delineados pelas entidades médicas em um ou ambos os índices, ver tabela 6.1. Dentro deste último grupo consideramos os indivíduos que sofrem de hipertensão arterial sistólica isolada, caracterizada por valores de pressão arterial sistólica superior ou igual a 140 mmHg e valor de pressão arterial diastólica inferior a 90 mmHg. Pretendemos estudar valores elevados de pressão arterial sistólica neste grupo. Em primeira análise, foi efectuado um estudo descritivo dos indivíduos que frequentaram a campanha e que sofrem de hipertensão sistólica isolada, com o intuito de averiguar o efeito de outras variáveis de interesse nos níveis de pressão arterial sistólica. As variáveis consideradas nesta analise preliminar foram a idade, cuja relação com valores elevados de pressão arterial sistólica é conhecida, ver [Pinto, 2007]; o género, consumo de tabaco, índice de massa corporal e distrito. A análise de valores extremos utilizando a metodologia Peaks Over Threshold consiste em várias etapas. Em primeiro lugar, é necessário obter o valor limiar elevado (threshold) com o objectivo de ajustar uma distribuição generalizada de Pareto aos seus excessos. Esta distribuição tem parâmetro de forma k e parâmetro de escala s, ver expressão (3.2). Esta primeira etapa é por vezes difícil. A literatura apresenta várias metodologias para tratar esta fase. Existem métodos exploratórios, como o descrito por [Coles, 2001], que utiliza a função de excesso médio para discernir o limiar elevado pretendido. [DuMouchel, 1983] sugere utilizar c0:9 como valor limiar. Existem também métodos que consistem em ajustar o modelo considerando vários valores limiar e avaliar qual produz o melhor ajustamento, como por exemplo os testes de Cramér-von Mises e Anderson-Darling, ver [Choulakian and Stephens, 2001]. Ainda dentro deste grupo destacamos um método Bayesiano que utiliza medidas de surpresa, ver [Lee et al., 2015]. Todos os métodos referidos acima são utilizados ao longo da dissertação. Após concluída esta fase procedemos ao ajuste de uma distribuição generalizada de Pareto aos excessos do valor limiar seleccionado. Máxima verosimilhança é a metodologia mais usual para efectuar o ajustamento visto que os resultantes estimadores dos parâmetros gozam de propriedades relevantes. Numa primeira etapa, implementamos a metodologia Peaks Over Threshold nos indivíduos que sofrem de pressão arterial sistólica isolada em cada distrito de Portugal continental e ilhas. Aqui são exploradas as dificuldades inerentes na análise de valores extremos e também alguns problemas encontrados nos dados, os quais são explorados no capítulo seguinte, onde analisamos os valores de pressão arterial sistólica em indivíduos idosos, (idade superior ou igual a 55) e consideramos um método que trata o problema de testes múltiplos para hipóteses ordenadas. Estas resultam da aplicação dos testes de Cramér-von Mises e Anderson-Darling para diferentes partições da amostra; e consideramos também modelos jittering para lidar com o problema de discretização dos dados.It has been well stated that high values of blood pressure constitute a risk factor for cardiovascular diseases [Hajar, 2016], with the latter being the number one death cause in Portugal. With the objectiveof profiling the Portuguese population in what regards cardiovascular diseases’ risk factors, a study was developed and carried out in 2005, by the National Pharmacy Association through its Department of Pharmaceutical Care. The main interest of the present study is to model the high values of systolic blood pressure of individuals with a specific hypertension pathology. A similar study was developed for the total cholesterol levels [de Zea Bermudez and Mendes, 2012]. The aims of this dissertation are twofold: to study the geographical distribution of the high systolic blood pressure (but normal diastolic blood pressure) in Portugal, i.e., fitting extreme value models for each Portuguese district and islands and studying the group that is more at risk, i.e., the elderly. With that purpose, the Peaks Over Threshold methodology was applied, which consists in finding a sufficiently high systolic blood pressure threshold and fitting a tail model to the excesses. The models will be able to estimate extreme quantiles and tail probabilities of the systolic blood pressure in each group

The impact of vaccination on the evolution of COVID-19 in Portugal

DOCTORATES 4 COVID-19", number 2020.10172.BD. PP UIDB/00297/2020 UIDB/04621/2020 UIDP/04621/2020In this work we use simple mathematical models to study the impact of vaccination against COVID-19 in Portugal. First, we fit a SEIR type model without vaccination to the Portuguese data on confirmed cases of COVID-19 by the date of symptom onset, from the beginning of the epidemic until the 23rd January of 2021, to estimate changes in the transmission intensity. Then, by including vaccination in the model we develop different scenarios for the fade-out of the non pharmacological intervention (NPIs) as vaccine coverage increases in the population according to Portuguese vaccination goals. We include a feedback function to mimic the implementation and relaxation of NPIs, according to some disease incidence thresholds defined by the Portuguese health authorities.publishersversionpublishe

a modelling study for Portugal

Funding Information: The authors acknowledge financial support from the Fundação para a Ciência e Tecnologia - FCT through project “Projection of the Impact of Non-pharmacological real-time Control and mitigation measures for the COVID-19 epidemic” (COVID-19 in-CTRL) - project n° 692 from the 2nd edition of RESEARCH 4 COVID-19. The first author also acknowledges FCT within the PhD grants program “DOCTORATES 4 COVID-19”, Grant No 2020.10172.BD. The second author also acknowledges FCT within projects UIDB/04621/2020 and UIDP/04621/2020. The third author also acknowledges FCT within the Strategic Project UIDB/00297 /2020 (Centro de Matemática e Aplicações, Universidade Nova de Lisboa ). Publisher Copyright: © 2022 The Author(s)Vaccination strategies to control COVID-19 have been ongoing worldwide since the end of 2020. Understanding their possible effect is key to prevent future disease spread. Using a modelling approach, this study intends to measure the impact of the COVID-19 Portuguese vaccination strategy on the effective reproduction number and explore three scenarios for vaccine effectiveness waning. Namely, the no-immunity-loss, 1-year and 3-years of immunity duration scenarios. We adapted an age-structured SEIR deterministic model and used Portuguese hospitalisation data for the model calibration. Results show that, although the Portuguese vaccination plan had a substantial impact in reducing overall transmission, it might not be sufficient to control disease spread. A significant vaccination coverage of those above 5 years old, a vaccine effectiveness against disease of at least 80% and softer non-pharmaceutical interventions (NPIs), such as mask usage and social distancing, would be necessary to control disease spread in the worst scenario considered. The immunity duration scenario of 1-year displays a resurgence of COVID-19 hospitalisations by the end of 2021, the same is observed in 3-year scenario although with a lower magnitude. The no-immunity-loss scenario presents a low increase in hospitalisations. In both the 1-year and 3-year scenarios, a vaccination boost of those above 65 years old would result in a 53% and 38% peak reduction of non-ICU hospitalisations, respectively. These results suggest that NPIs should not be fully phased-out but instead be combined with a fast booster vaccination strategy to reduce healthcare burden.publishersversionpublishe

CONSTRUÇÃO DO HIPÓDROMO DE UVARANAS NO MUNICÍPIO DE PONTA GROSSA-PR: UMA ANÁLISE DE CONJUNTURA

Resumo: O presente estudo objetivou efetuar uma análise de conjuntura acerca da construção do Hipódromo de Uvaranas (Prado), localizado no município de Ponta Grossa-PR. A coleta de dados ocorreu através de busca em documentos disponíveis na Casa da Memória de Ponta Grossa-PR, bem como em jornais, livros e artigos que abordavam o Hipódromo de Uvaranas ou a sociedade Pontagrossense no final do século XIX. Observou-se que a expansão do turfe brasileiro no final do século XIX e o interesse político nacional pela prática da equinocultura impulsionaram o turfe no município de Ponta Grossa – PR. Além disso, havia um forte engajamento político e social que oportunizou aos fundadores construir o Hipódromo de Uvaranas sem encontrar resistência.Palavras-chave: Hipódromo; Ponta Grossa; História. Construction of the Uvaranas Hippodrome in the Municipality of Ponta Grossa-PR: A Conjuncture Analysis Abstract: This study aims to carry out an analysis of the situation regarding the construction of the Hippodrome of Uvaranas (Prado) located in the municipality of Ponta Grossa-PR. Data collection took place by searching documents available at the Memory House of Ponta Grossa-PR, as well as in newspapers, books and articles that addressed the Hippodrome of Uvaranas or Ponta-Grossense society at the end of the 19th century. It was observed that the expansion of Brazilian turf in the late 19th century and the national political interest in the practice of equinoculture boosted the turf in Ponta Grossa-PR city. In addition, there was a strong political and social interest that made it possible for the founders not to encounter resistance for the construction of the Hippodrome de Uvaranas.Keywords: Hippodrome; Ponta grossa; History. Construcción del hipódromo de Uvaranas em la Ciudade de Ponta Grossa-PR: um análisis de conjunción Resumem: El presente trabajo tiene por objeto realizar un análisis de coyuntura de la construcción del Hipódromo de Uvaranas (prado) ubicado en la ciudad de Ponta Grossa. La recopilación de datos realizó mediante la búsqueda de documentos disponibles en la Casa de la Memoria de Ponta Grossa-PR, así como en periódicos, libros y artículos que se dirigieron al Hipódromo de Uvaranas o la sociedad Pontagrossense a fines del siglo XIX. Se observó que la expansión del turfe brasileño a fines del siglo XIX y el interés político nacional en la práctica de la equinocultura impulsió el turfe en la cidad de Ponta Grossa-PR. Además, hubo un fuerte interés político y social que hizo posible que los fundadores no encontraran resistencia para la construcción del Hipódromo de Uvaranas.Palabras-Clave: Hipódromo; Ponta Grossa; Historia

Muscle strength training is better than the use of growth hormone (GH) in bone health of wistar rats

The objective of this study was to evaluate the effects of growth hormone (GH) and muscle strength training (ST) on the composition of bone tissue of Wistar rats through Raman spectroscopy. In total, 40 male rats were randomly distributed into four groups: (N = 10) control (C), control with the application of GH (GHC), strength training (T), and strength training with the application of GH (GHT). The training consisted of four series of 10 water jumps, performed three times a week, with an overload corresponding to 50 % of body weight and duration of four weeks. GH was applied at a dose of 0.2 IU / kg in each animal three times a week and every other day. After four weeks, the animals were euthanized and the right femurs collected for analysis of the bone structure. Raman spectroscopy (FR) was used to observe the following compounds from their respective bands: Calcium Carbonate-Triglycerides (fatty acids) 1073 cm(-1), Collagen type I 509 cm(-1), Bone-DNA Phosphate (Protein) 589 cm(-1), Phosphate Phospholipids 1078 cm(-1). For the statistical analysis, the Shapiro-Wilk and ANOVA One-Way variance analysis normality tests were performed, followed by the Tukey post-test The results showed an increase in the concentrations of calcium carbonate-triglycerides (fatty acids), type I collagen, bone phosphate-DNA (protein), and phosphate phospholipids in all experimental groups, with or without ST and/or GH , But only the isolated training group differed significantly from the control group (P <0.05). It was concluded that all treatments could promote bone tissue gain, however, only the T group demonstrated a significant difference in the mineral compounds analyzed371104110COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESSem informaçã

Relative vaccine effectiveness against COVID-19 hospitalisation in persons aged ≥ 65 years: results from a VEBIS network, Europe, October 2021 to July 2023

VEBIS-Lot 4 working group: James Humphreys, Alexis Sentís, Joris Van Loenhout, Pierre Hubin, Katrine Finderup Nielsen, Chiara Sacco, Daniele Petrone, Patrizio Pezzotti, Itziar Casado, Aitziber Echeverria, Camino Trobajo-Sanmartín, Stijn Andeweg, Anja Bråthen Kristoffersen, Irina Kislaya, Patricia Soares, Carlos Dias, Ausenda Machado.Since 2021, the Vaccine Effectiveness, Burden and Impact Studies of coronavirus disease 2019 (COVID-19) and influenza (VEBIS) project monitors vaccine effectiveness (VE) in real-world conditions to inform vaccination programmes in the European Union/European Economic Area (EU/EEA) countries [1]. One project aims to monitor real-time COVID-19 VE using electronic health registries (EHR) in multiple countries, with initial findings previously published [2-4]. We report pooled VE results against hospitalisation due to COVID-19 by number of doses received and time since vaccination in a community-dwelling resident population aged ≥ 65 years between October 2021 and July 2023.info:eu-repo/semantics/publishedVersio

Does the white coat influence satisfaction, trust and empathy in the doctor-patient relationship in the General and Family Medicine consultation? Interventional study

Objectives To understand the influence of the white coat on patient satisfaction, opinions about medical clothing, perception about confidence, empathy and medical knowledge and the satisfaction and comfort level of physicians in consultation. Setting An interventional study was conducted with a representative sample of the population attending primary care in central Portugal. Participants The sample was composed by 286 patients divided into two groups exposed or not to a doctor wearing a white coat. The first and last patients in consultation every day for 10 consecutive days were included. Interventions Every other day the volunteer physicians consulted with or without the use of a white coat. At the end of the consultation, a questionnaire was distributed to the patient with simple questions with a Likert scale response, the Portuguese version of the ‘Trust in physician’ scale and the Jefferson Scale of Patient Perceptions of Physician Empathy - Portuguese Version (JSPPPE-VP scale). A questionnaire was also distributed to the physician. Outcomes Planned and measured primary outcomes were patient satisfaction, trust and perception about empathy and secondary outcomes were opinion about medical clothing, satisfaction and comfort level of physicians in consultation. Results The sample was homogeneous in terms of sociodemographic variables. There were no statistically significant differences between the groups in terms of satisfaction, trust, empathy and knowledge perceived by the patients. There were differences in the opinion of the patients about the white coat, and when the physician was wearing the white coat this group of patients tended to think that this was the only acceptable attire for the physician (p<0.001). But when the family physician was in consultation without the white coat, this group of patients tended to agree that communication was easier (p=0.001). Conclusions There was no significant impact of the white coat in patient satisfaction, empathy and confidence in the family physician. Trial registration number ClinicalTrials. gov ID number: NCT0396541

Pregnancy during COVID-19: social contact patterns and vaccine coverage of pregnant women from CoMix in 19 European countries

CoMix Europe Working Group: Daniela Paolotti, André Karch, Veronika Jäger, Joaquin Baruch, Tanya Melillo, Henrieta Hudeckova, Magdalena Rosinska, Marta Niedzwiedzka-Stadnik, Krista Fischer, Sigrid Vorobjov, Hanna Sõnajalg, Christian Althaus, Nicola Low, Martina Reichmuth, Kari Auranen, Markku Nurhonen, Goranka Petrović, Zvjezdana Lovric Makaric, Sónia Namorado, Constantino Caetano, Ana João Santos, Gergely Röst, Beatrix Oroszi, Márton Karsai, Mario Fafangel, Petra Klepac, Natalija Kranjec, Cristina Vilaplana, Jordi Casabona.CoMix Europe Working Group: Sónia Namorado, Constantino Caetano, and Ana João Santos (Department of Epidemiology, National Institute of Health Dr Ricardo Jorge, Portugal)Background: Evidence and advice for pregnant women evolved during the COVID-19 pandemic. We studied social contact behaviour and vaccine uptake in pregnant women between March 2020 and September 2021 in 19 European countries. Methods: In each country, repeated online survey data were collected from a panel of nationally-representative participants. We calculated the adjusted mean number of contacts reported with an individual-level generalized additive mixed model, modelled using the negative binomial distribution and a log link function. Mean proportion of people in isolation or quarantine, and vaccination coverage by pregnancy status and gender were calculated using a clustered bootstrap. Findings: We recorded 4,129 observations from 1,041 pregnant women, and 115,359 observations from 29,860 non-pregnant individuals aged 18-49. Pregnant women made slightly fewer contacts (3.6, 95%CI = 3.5-3.7) than non-pregnant women (4.0, 95%CI = 3.9-4.0), driven by fewer work contacts but marginally more contacts in non-essential social settings. Approximately 15-20% pregnant and 5% of non-pregnant individuals reported to be in isolation and quarantine for large parts of the study period. COVID-19 vaccine coverage was higher in pregnant women than in non-pregnant women between January and April 2021. Since May 2021, vaccination in non-pregnant women began to increase and surpassed that in pregnant women. Interpretation: Limited social contact to avoid pathogen exposure during the COVID-19 pandemic has been a challenge to many, especially women going through pregnancy. More recognition of maternal social support desire is needed in the ongoing pandemic. As COVID-19 vaccination continues to remain an important pillar of outbreak response, strategies to promote correct information can provide reassurance and facilitate informed pregnancy vaccine decisions in this vulnerable group.HPRU in Modelling & Health Economics,NIHR200908,European Union’s Horizon 2020 research and innovation programme,EpiPose 101003688,TransMID 682540,TransMID 682540,TransMID 682540,EpiPose 101003688,Wellcome Trust,213589/Z/18/Z,National Institute for Health Research,CV220-088—COMIX,CV220-088—COMIX,CV220-088— COMIX,Global Challenges Research Fund,ES/P010873/1,Medical Research Council,MC_PC_19065,NIHR,PR-OD-1017-20002 HPRU in Modelling & Health Economics (NIHR200908: KLMW); European Union Horizon 2020 research and innovation programme – (EpiPose 101,003,688: AG, WJE). Wellcome Trust (213,589/Z/18/Z: ESP). European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (TransMID 682,540: CF, PN, NH). This research was partly funded by the Global Challenges Research Fund (GCRF) project RECAP managed through RCUK and ESRC (ES/P010873/1: CIJ). NIHR (PR-OD-1017–20,002: WJE) UK MRC (MC_PC_19065—Covid 19: Understanding the dynamics and drivers of the COVID-19 epidemic using real-time outbreak analytics: WJE).info:eu-repo/semantics/publishedVersio