Where to find the answers - a cross-sectional study

Funding: The present publication was funded by Fundac¸ão Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020).INTRODUCTION: Clinicians raise at least one question for every two patients they see, but search for an answer to less than half of these questions, and rarely use evidence-based resources. One barrier to evidence-based practice is doubt that the search would yield an answer, and we found insufficient evidence to refute this concern. This study aims to identify what proportion of clinical questions in primary care can be answered with online evidence-based practice resources, and what proportion of these can be answered with pre-appraised evidence. MATERIALS AND METHODS: Cross-sectional study in two primary care practices. The inclusion criteria were family doctors, generalists and residents working in 2 selected practices. We collected a total of 238 questions from 19 family medicine specialists, 9 family medicine residents and 3 generalist doctors. Doctors were asked to record any clinical question that arose during 4 days of appointments. The primary outcome was the proportion of clinical questions answered with online evidence-based practice resources. The secondary outcome was the level of evidence needed to reach to find the answers (clinical summaries, systematic guidelines, systematic reviews or primary studies), according to Haynes' pre-appraised evidence pyramid model. RESULTS: 191 of the 206 valid clinical questions could be answered with online evidence-based practice resources (92.7% [95% CI 88.3%-95.9%]). Most of these questions (90.8% CI 95% 85.9%-94.4%) were successfully answered using clinical summaries (BMJ Best Practice, DynaMed or UpToDate), with a median search time of 4 minutes (range 1-16.5). CONCLUSIONS: Contrary to clinician's beliefs, the majority of clinical questions can be answered with online evidence-based practice resources, and most of them with pre-appraised evidence. This study could encourage family doctors to increase the use of clinical summaries. Furthermore, these results highlight the importance of teaching how to search for and apply pre-appraised evidence.publishersversionpublishe

Rethinking the choosing wisely portugal recommendation on breast cancer screening

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Geochemical fingerprinting of Roman pottery production from Manta Rota kilns (Southern Portugal)

The Roman site of Manta Rota, located in Algarve region, Portugal, is known from the XIXth century when Estacio da Veiga recovered a few pottery fragments and identified the foundations of Roman structures. References in early XXth century refer to a pottery kiln and to the remains of both amphorae and lamps. In 1992, emergency excavations directed by Cristina Garcia excavated a structure identified as a kiln and recovered abundant amphorae fragments of a locally produced Dressel 14 type. There is evidence of production of tiles, common ware and amphora. The study of the remains collected (terra sigillata and amphorae) in the excavations shows that Roman occupation of the site covers a period from the middle of the 1st century until the 5th century AD. The major production of the kiln area was the Dressel 14 fish sauce amphora centered in the middle/second half of the 1st century but the production of Almagro 51c is also attested. A preliminary macroscopic analysis of both the amphorae and the common ware show identical features. The aim of this paper is to present chemical characterization of the production of Manta Rota and to compare the results with different workshops in the Algarve region as Quinta do Lago, near Faro or S. Bartolomeu de Castro Marim, in the proximity of the studied area, in order to establish geochemical fingerprints of Manta Rota ceramic production center. Preliminary results point to a fine geochemical differentiation of the Manta Rota ceramics in comparison with the other two roman production centers of Algarve region

Microbial assessment in a rare Norwegian book collection: a One Health approach to cultural heritage

This research was funded by the EEA Grant Fund for Bilateral Relations “Microbiological contamination in cultural heritage settings: shared experiences for better approaches” (FBR_OC2_66_NOVA.ID.FCT). S. Sequeira and E. Pasnak gratefully acknowledge the support by the Portuguese Fundação para a Ciência e a Tecnologia (FCT/MCTES) through research grants (CEECIND/01474/2018 and UI/BD/153082/2022) and LAQV-REQUIMTE funding. This project was supported by FCT/MCTES UIDP/05608/2020 and UIDB/05608/2020. This work was also supported by national funds through FCT/MCTES/FSE/UE, 2023.01366.BD; UI/BD/153746/2022 and CE3C unit UIDB/00329/2020, UI/BD/151431/2021, and by Instituto Politécnico de Lisboa, national support through IPL/2022/InChildhealth/BI/12M; IPL/IDI&CA2023/FoodAIIEU_ESTeSL; IPL/IDI&CA2023/ASPRisk_ESTeSL; IPL/IDI&CA2023/AR AFSawmills_ESTeSL. This project was also supported by the Polish Minister of Science and Higher Education, under the program “Regional Initiative of Excellence” in 2019–2022 (GrantNo. 008/RID/201/19). C. Pinheiro acknowledges the FCT/MCTES support through CEECIND/02598/2017. C. Pinheiro, M. Penetra, I. Silva, and T. Caldeira acknowledge support from UIDB/04449/2020, UIDP/04449/2020, and LA/P/0132/2020. M. Penetra acknowledges the financial support of the project “ROADMAP—Research on Antonio De Holanda Miniatures Artistic Production” (PTDC/ART-HIS/0985/2021), financed by Portuguese funds through FCT/MCTES. I. Santos acknowledges financial support to FCT-MCTES within the scope of the project UI/BD/153582/2022.Microbial contamination poses a threat to both the preservation of library and archival collections and the health of staff and users. This study investigated the microbial communities and potential health risks associated with the UNESCO-classified Norwegian Sea Trade Archive (NST Archive) collection exhibiting visible microbial colonization and staff health concerns. Dust samples from book surfaces and the storage environment were analyzed using culturing methods, qPCR, Next Generation Sequencing, and mycotoxin, cytotoxicity, and azole resistance assays. Penicillium sp., Aspergillus sp., and Cladosporium sp. were the most common fungi identified, with some potentially toxic species like Stachybotrys sp., Toxicladosporium sp., and Aspergillus section Fumigati. Fungal resistance to azoles was not detected. Only one mycotoxin, sterigmatocystin, was found in a heavily contaminated book. Dust extracts from books exhibited moderate to high cytotoxicity on human lung cells, suggesting a potential respiratory risk. The collection had higher contamination levels compared to the storage environment, likely due to improved storage conditions. Even though overall low contamination levels were obtained, these might be underestimated due to the presence of salt (from cod preservation) that could have interfered with the analyses. This study underlines the importance of monitoring microbial communities and implementing proper storage measures to safeguard cultural heritage and staff well-being.info:eu-repo/semantics/publishedVersio

Caffeine Consumption and Mortality in Diabetes: An Analysis of NHANES 1999–2010

Aim: An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the effect of coffee consumption in diabetes remains unclear. We aimed to evaluate the association of caffeine consumption and caffeine source with mortality among patients with diabetes.Methods: We examined the association of caffeine consumption with mortality among 1974 women and 1974 men with diabetes, using the National Health and Nutrition Examination Survey (NHANES) 1999–2010. Caffeine consumption was assessed at baseline using 24 h dietary recalls. Cox proportional hazard models were fitted to estimate hazard ratios (HR) for all-cause, cardiovascular, and cancer-related mortality according to caffeine consumption and its source, adjusting for potential confounders.Results: A dose-dependent inverse association between caffeine and all-cause mortality was observed in women with diabetes. Adjusted HR for death among women who consumed caffeine, as compared with non-consumers, were: 0.57 (95% CI, 0.40–0.82) for <100 mg of caffeine/day, 0.50 (95% CI, 0.32–0.78) for 100 to <200 mg of caffeine/day, and 0.39 (95% CI, 0.23–0.64) for ≥200 mg of caffeine/day (p = 0.005 for trend). This association was not observed in men. There was a significant interaction between sex and caffeine consumption (p = 0.015). No significant association between total caffeine consumption and cardiovascular or cancer mortality was observed. Women who consumed more caffeine from coffee had reduced risk of all-cause mortality (p = 0.004 for trend).Conclusion: Our study showed a dose-dependent protective effect of caffeine consumption on mortality among women with diabetes

Prescribing of Non-Steroidal Anti-Inflammatory Drugs to Patients with Diabetes Mellitus in Portugal

Introduction: Portugal presents the highest incidence of stage 5 chronic kidney disease in Europe. It is speculated that a high consumption of non-steroidal anti-inflammatory drugs (NSAIDS) may contribute to this high incidence. Our aim was to characterize the prescription of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus in Portugal. Material and Methods: We analyzed the national prescription database in triennium 2015 - 2017. In patients with diabetes mellitus, we evaluated the prescription of non-steroidal anti-inflammatory drugs according to age, gender and region of the patient and specialty of the prescribing physician. We evaluated the prescription of non-steroidal anti-inflammatory drugs in all patients with diabetes mellitus, in patients with presumed renal impairment, and in those with concomitant prescription of angiotensin converting enzyme inhibitors or angiotensin receptor antagonists. Results: We analyzed 23 320 620 prescriptions, corresponding to 610 157 adults, including 104 306 patients with diabetes mellitus. The most prescribed non-steroidal anti-inflammatory drugs were ibuprofen (20.1%), metamizole (14.7%), and diclofenac (11.4%). The prescription of non-steroidal anti-inflammatory drugs was higher in females, in patients aged 51 - 70 years and in the Alentejo region. Non-steroidal anti-inflammatory drugs were prescribed to 70.6% of patients with diabetes mellitus, from which 10.6% were prescribed ≥ 10 packages during the three years. Among patients with diabetes mellitus on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and with presumed reduction in kidney function, 69.3% were prescribed non-steroidal anti-inflammatory drugs and 11.5% were prescribed ≥ 10 packages during the three years. Discussion: The level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus is high. The concern of reducing non-steroidal anti-inflammatory drugs prescription to patients already on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and/or decreased renal function does not seem to exist. Conclusion: In Portugal, the level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus should be reduced, particularly in the subgroups identified with higher prescription and with higher risk of progression to stage 5 chronic kidney disease

Choosing Wisely Portugal – Escolhas Criteriosas em Saúde

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Hexapoda Yearbook (Arthropoda: Mandibulata: Pancrustacea) Brazil 2020: the first annual production survey of new Brazilian species

This paper provided a list of all new Brazilian Hexapoda species described in 2020. Furthermore, based on the information extracted by this list, we tackled additional questions regarding the taxa, the specialists involved in the species descriptions as well as the journals in which those papers have been published. We recorded a total of 680 new Brazilian species of Hexapoda described in 2020, classified in 245 genera, 112 families and 18 orders. These 680 species were published in a total of 219 articles comprising 423 different authors residing in 27 countries. Only 30% of these authors are women, which demonstrates an inequality regarding sexes. In relation to the number of authors by species, the majority of the new species had two authors and the maximum of authors by species was five. We also found inequalities in the production of described species regarding the regions of Brazil, with Southeast and South leading. The top 10 institutions regarding productions of new species have four in the Southeast, two at South and with one ate North Region being the outlier of this pattern. Out of the total 219 published articles, Zootaxa dominated with 322 described species in 95 articles. The average impact factor was of 1.4 with only seven articles being published in Impact Factors above 3, indicating a hardship on publishing taxonomic articles in high-impact journals.The highlight of this paper is that it is unprecedent, as no annual record of Hexapoda species described was ever made in previous years to Brazil.Fil: Silva Neto, Alberto Moreira. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Lopes Falaschi, Rafaela. Universidade Estadual do Ponta Grossa; BrasilFil: Zacca, Thamara. Universidade Federal Do Rio de Janeiro. Museu Nacional; BrasilFil: Hipólito, Juliana. Universidade Federal da Bahia; BrasilFil: Costa Lima Pequeno, Pedro Aurélio. Universidade Federal de Roraima; BrasilFil: Alves Oliveira, João Rafael. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Oliveira Dos Santos, Roberto. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Heleodoro, Raphael Aquino. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Jacobina, Adaiane Catarina Marcondes. Universidade Federal do Paraná; BrasilFil: Somavilla, Alexandre. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Camargo, Alexssandro. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: de Oliveira Lira, Aline. Universidad Federal Rural Pernambuco; BrasilFil: Sampaio, Aline Amanda. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: da Silva Ferreira, André. Universidad Federal Rural Pernambuco; BrasilFil: Martins, André Luis. Universidade Federal do Paraná; BrasilFil: Figueiredo de Oliveira, Andressa. Universidade Federal do Mato Grosso do Sul; BrasilFil: Gonçalves da Silva Wengrat , Ana Paula. Universidade do Sao Paulo. Escola Superior de Agricultura Luiz de Queiroz; BrasilFil: Batista Rosa, Augusto Henrique. Universidade Estadual de Campinas; BrasilFil: Dias Corrêa, Caio Cezar. Universidade Federal Do Rio de Janeiro. Museu Nacional; BrasilFil: Costa De-Souza, Caroline. Museu Paraense Emilio Goeldi; BrasilFil: Anjos Dos Santos, Danielle. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagónica. Universidad Nacional de la Patagonia "San Juan Bosco". Centro de Investigación Esquel de Montaña y Estepa Patagónica; ArgentinaFil: Pacheco Cordeiro, Danilo. Instituto Nacional Da Mata Atlantica; BrasilFil: Silva Nogueira, David. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Almeida Marques, Dayse Willkenia. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Nunes Barbosa, Diego. Universidade Federal do Paraná; BrasilFil: Mello Mendes, Diego Matheus. Instituto de Desenvolvimento Sustentável Mamirauá; BrasilFil: Galvão de Pádua, Diego. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Silva Vilela, Diogo. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Gomes Viegas, Eduarda Fernanda. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Carneiro dos Santos, Eduardo. Universidade Federal do Paraná; BrasilFil: Rodrigues Fernandes, Daniell Rodrigo. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; Brasi

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio