National trends in the use of oral chemotherapy over 13 years

Funding Information: To the expert panel who validated the CDDs for the three indications and INFARMED I.P. for making data available. Publisher Copyright: Copyright © 2022 Moreira, Bernardo, Ramos, Aguiar and Alves da Costa.Background: Systemic cancer therapy has traditionally been administered using an intravenous (IV) route, implying patients’ frequent visits to hospitals to access to their therapy. If we consider the actual pipeline in oncology, oral chemotherapy will be the main component of cancer treatment in the next few years. This shift in the administration route requires different care models in order to guarantee treatment efficacy and safety. Objective: To analyze time trends in oral chemotherapy consumption in Portugal. Method: Oral chemotherapy consumption over a 13-year period (2008–2020) was analyzed, considering dispensed units by the administration route with respective costs, resorting to the drug regulatory agency (INFARMED I.P.) database. Oral consumption patterns were further explored using common daily doses (CDD) for three conditions, including chronic myeloid leukemia (CML), non-small-cell lung cancer (NSCLC), and breast cancer (BC), to adjust for the effect of varying doses. Data were analyzed descriptively resorting to Microsoft Office Excel 2010. Results: Overall chemotherapy consumption increased +Δ54.7%, with the highest contribution in units observed in oral forms (+Δ58.8%). The total expenditure increased +Δ96.5%, and despite the increase in oral forms (+Δ221.6%), intravenous forms continued to be the major cost driver, with an important contribution from immunotherapy. Much of the increase was led by the approval of 40 new IV and 48 new oral cancer medications with higher costs introduced in the market. Using CDD as an alternative metric to units had varying impacts by indication. The observed increases seemed to focus on specific cancer sites with varying effect; in CML, there was a 2.39-fold increase, compared to 4.41 for NSCLC and 1.86 for BC. However, for BC, two distinct sub-patterns were observed for hormone therapy (increasing 1.83) and for the novel tyrosine kinase inhibitors (increasing 40.8). Conclusion: The growing use of oral chemotherapy is obvious and calls for investments in supporting patients in managing medication adherence and adverse events. The shifts in the healthcare system are complex and need to be prioritized. Our data suggest that priority could be attributed to cancer sites driving innovation, namely, advanced breast cancer.publishersversionpublishe

Antibodies directed to antigens secreted by murine epithelioid macrophages modulate BCG-induced granulomata

The authors have previously shown that epithelioid cells isolated from mice secrete a factor, called macrophage deactivating factor (MDF), that promptly deactivates superoxide release by activated macrophages and neutrophils. In this paper some biological properties of a polyclonal rat antiserum directed to MDF and other substances secreted by these cells are described. The immunoglobulin fraction of this antiserum reacted, by immunocytochemical methods, with epitopes in the cell membrane of macrophages adherent to coverslips subcutaneously implanted for 14 days; but not for 5 days. It also reacted with antigens within and outside cells in BCG-induced granulomas. This antiserum blocked completely the macrophage deactivating activity of epithelioid cell culture supernatants. Anti-IL-10 monoclonal antibody, did not block MDF activity. The administration of the immunoglobulin fraction from immunized rats to C5 deficient mice bearing BCG-induced granulomatas in the footpad, significantly reduced the size of the lesions. A marked necrosis of inflammatory cells and mononuclear cells phagocyting debris of necrotic cells were observed in these lesions

Atitudes do enfermeiro em contexto de ensino clínico: uma revisão da literatura

Com o decorrer do Ensino Clínico torna-se crucial compreender de que modo as atitudes dos enfermeiros influenciam o desempenho dos alunos. Cuidados de excelência só podem ser assegurados com a passagem de testemunho do Enfermeiro para o aluno. Nesta linha, as atitudes que os enfermeiros supervisores apresentam, tornam-se o “espelho” e o reflexo do futuro profissional. O supervisor tem a capacidade de melhorar a qualidade da formação do estudante, sendo que este tem o dever de ser o catalisador da mudança. Um processo interactivo e dinâmico facilitador da aprendizagem experiencial que permite a melhoria e a continuidade dos cuidados

A roadmap for lifting restrictive measures for COVID-19

After more than one year of the pandemic, we now know that no single preventive measure affords fully effective control of virus transmission. Therefore, it is vital to combine different approaches to quickly identify the cases, trace their contacts, constantly reduce the risk of transmission, promptly respond to outbreaks or community transmission and monitor the circulating SARS-CoV-2 variants. The updated Strategic Framework presented sets out tools that were used to restore, in a phased approach, normality to life in Portugal on 11 March 2021. Immediate short-term government responses are needed to save lives and livelihoods. However, the crisis could also provide valuable lessons for longer-term resilience of systems that support well-being over time, such as social connections and social capital, opening up new ways of working and living, and reinforcing the capacity of public services and social safety nets to react in times of crisis. Should COVID-19 move to being an endemic or seasonal disease such as influenza, the lessons learned from the response to the pandemic will be helpful in successful containing and preventing new waves of COVID-19.The authors would like to thank S Marques and B Monteiro for the table design and formatting. AA holds a PhD Grant (Ref. 2020.09390.BD), co-funded by the FCT and the Fundo Social Europeu (FSE) Program

COVID-19 vaccines effectiveness against symptomatic disease and severe outcomes, 2021-2022: a test-negative case-control study

Objectives: This study evaluated the effectiveness of COVID-19 vaccines in preventing symptomatic and severe disease.Study design: This was an observational test-negative case-control study.Methods: Study participants were adults with at least one symptom included in the World Health Or-ganization COVID-19 definition who sought health care in a public emergency department between 1 November 2021 and 2 March 2022 (corresponding with the fifth pandemic wave in Portugal dominated by the Omicron variant). This study used multivariable logistic regression models to estimate and compare the odds ratio of vaccination between test-positive cases and test-negative controls to calculate the absolute and relative vaccine effectiveness.Results: The study included 1059 individuals (522 cases and 537 controls) with a median age of 56 years and 58% were women. Compared with the effectiveness of the primary vaccination scheme that had been completed >= 180 days earlier, the relative effectiveness against symptomatic infection of a booster administered between 14 and 132 days earlier was 71% (95% confidence interval [CI]: 57%, 81%; P = 180 days.Conclusions: Despite the known immunological evasion characteristics of the Omicron variant, results from this study show that vaccine effectiveness increases after booster administration. COVID-19 vaccine effectiveness decreases to less than 50% between 3 and 6 months after completion of the primary cycle; therefore, this would be an appropriate time to administer a booster to restore immunity.(c) 2023 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Ana Aguiar holds a PhD grant (Reference: 2020.09390.BD) , co-funded by the Fundacao para a Ciencia e a Tecnologia (FCT) and the Fundo Social Europeu (FSE) Program

Canine parvovirus : a predicting canine model for sepsis

Research Areas: Veterinary SciencesBackground: Sepsis is a severe condition associated with high prevalence and mortality rates. Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression. This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. The main objective of the present study was to evaluate the differences between two sets of SIRS (Systemic Inflammatory Response Syndrome) criteria in outcome prediction: SIRS 1991 and SIRS 2001. The possibility of stratifying and classifying septic dogs was assessed using a proposed animal adapted PIRO (Predisposition, Infection, Response and Organ dysfunction) scoring system. Results: The 72 dogs enrolled in this study were scored for each of the PIRO elements, except for Infection, as all were considered to have the same infection score, and subjected to two sets of SIRS criteria, in order to measure their correlation with the outcome. Concerning SIRS criteria, it was found that the proposed alterations on SIRS 2001 (capillary refill time or mucous membrane colour alteration) were significantly associated with the outcome (OR = 4.09, p < 0.05), contrasting with the 1991 SIRS criteria (p = 0.352) that did not correlate with the outcome. No significant statistical association was found between Predisposition (p = 1), Response (p = 0.1135), Organ dysfunction (p = 0.1135), total PIRO score (p = 0.093) and outcome. To explore the possibility of using the SIRS criteria as a fast decision-making tool, a Fast-andFrugal tree (FFT) was created with a sensitivity of 92% and a specificity of 29%. Conclusion: These results suggest that increasing the SIRS criteria specificity may improve their prognostic value and their clinical usefulness. In order to improve the proposed PIRO scoring system outcome prediction ability, more specific criteria should be added, mainly inflammatory and organ dysfunction biomarkers.info:eu-repo/semantics/publishedVersio

Structural changes in intestinal enteroendocrine cells after ileal interposition in normal rats

INTRODUCTION: No therapeutic approach has significantly impacted the progression of diabetes. As early improvement of glicaemic control is observed after bariatric surgeries, there is currently a search for surgical procedures that can promote euglycemia also in non-obese patients. Glicaemic control can be achieved by increasing the blood concentration of GLP-1, a hormone produced by L cells that are more densely concentrated in the terminal ileum. The interposition of ileal segment to a more anterior region (proximal jejunum) can promote a greater stimulation of the L cells by poorly digested food, increasing the production of GLP-1 and reflecting on glicaemic control.&#xd;&#xa;AIMS: To investigate long-term histological modifications of intestinal mucosa of rats submitted to interposition of ileum segment to a proximal region (jejunum).&#xd;&#xa;METHODS: Forty 8-week old male Wistar-EPM1 rats (Rattus norvegicus albinus) were randomly distributed into 3 groups: the Interposition Group (IG) was subjected to ileal interposition, the Sham Group (SG) was subjected to sham operations, and the Control Group (CG) was not subjected to surgery. All animals were followed until the 60th postoperative day (8 postoperative week) when they were euthanized. Segments of jejunum and ileum from all groups were collected and analyzed by optical microscopy and immunohistochemistry.&#xd;&#xa;RESULTS: No structural nor histological changes in intestinal L cells in the interposed intestinal segment and other intestinal segments were noted after ileal interposition surgery. &#xd;&#xa;CONCLUSION: As L cells endocrine characteristics were likely maintained, the use of metabolic surgical techniques for the treatment of metabolic diseases, especially diabetes, seems to be justified

Improving Students’ Social Participation in Primary and Secondary Schools Across Europe

This handbook is the product of collaboration within the “FRIEND-SHIP—Improving Students’ Social Participation in Primary and Secondary Schools Across Europe” Project, funded by the European Commission—Erasmus+ Programme, Project No.: 2019-1-AT01-KA201-05 1226. One of the main outputs of this Project consisted of the development of the FRIEND-SHIP Program, a school-based intervention aimed at improving social participation of all students between 8 and 11 years of age. The FRIEND-SHIP Program is intended to be implemented by teachers and consists of 12 sessions, each with the duration of 45–60 minutes, implemented twice a week over six weeks. The activities that comprise this program are essentially experiential. Students are invited to take an active and involved role by participating in group activities, role-playing, social stories, arts, and physical activities. The main purpose of this handbook is to support teachers in implementing the FRIEND-SHIP program with their classes. This handbook is divided in three parts: • CHAPTERS 1, 2 and 3 cover background information about social participation and inclusion, as well as the description of the target audience of this handbook and the digital tool for evaluating the FRIEND-SHIP Program effects. • CHAPTER 4 covers the FRIEND-SHIP Intervention Program, including guiding principles, aims, and detailed descriptions of sessions. • CHAPTER 5 covers the information gathered with the implementation of the FRIEND-SHIP Intervention Program throughout the Project life.This handbook is the product of collaboration within the “FRIEND-SHIP—Improving Students’ Social Participation in Primary and Secondary Schools Across Europe” Project, funded by the European Commission—Erasmus+ Programme, Project No.: 2019-1-AT01-KA201-05 1226.info:eu-repo/semantics/publishedVersio