Diferenças ao nível do género na adaptação psicossocial a curto prazo no pós enfarte agudo do miocárdio

O presente trabalho insere-se no âmbito de um estudo mais alargado e financiado pela Fundação para a Ciência e Tecnologia, com o POCTI n.º 35749/99 intitulado “Psychosocial outcomes in rehabilitation following myocardial infarction in Scottish and Portuguese women: A cross-cultural comparison”. Esta investigação foi efectuada numa sub-amostra desse estudo e contempla apenas a adaptação psicossocial a curto prazo ao enfarte agudo do miocárdio e algumas das variáveis utilizadas no projecto acima especificado. Assim, o objectivo principal desta investigação é avaliar as diferenças existentes ao nível do género, no processo de adaptação psicossocial a curto prazo, em doentes com enfarte agudo do miocárdio. Este estudo foi realizado numa amostra portuguesa de doentes com enfarte agudo do miocárdio, obtida em dois hospitais centrais da região norte (N=78; 46 homens e 32 mulheres). É um estudo de coorte, do tipo longitudinal correlacional/diferencial sendo os doentes avaliados em três momentos: dois dias após a admissão hospitalar; na altura da alta hospitalar (cerca de sete dias após a admissão); e quinze dias após a alta. Este estudo orienta-se pelos seguintes objectivos: Analisar as diferenças existentes entre homens e mulheres, no que respeita à adaptação psicossocial a curto prazo no pós enfarte agudo do miocárdio; descrever as representações de doença em doentes com enfarte agudo do miocárdio e compará-las ao nível do género, nos 3 momentos de avaliação; explorar a importância das variáveis sócio-demográficas e clínicas, na adaptação psicossocial a curto prazo; utilizar os resultados obtidos para fornecer pistas para o desenvolvimento de orientações para a reabilitação cardíaca a curto prazo, tendo em consideração o género. Em termos dos instrumentos de avaliação utilizados, estes foram seleccionados e adaptados para português no contexto do projecto financiado pelo FCT. Para avaliar a adaptação funcional foi utilizado o Sickness Impact Profile – SIP ; o Hospital Anxiety and Depression Scale – HADS para avaliar a adaptação emocional; e o Illness Perception Questionnaire Revised - IPQ-R para avaliar as representações de doença. Tendo em consideração o facto de não conhecermos estudos efectuados no nosso país que avaliassem as características psicométricas do HADS e do SIP, e apesar de não ser um objectivo principal a validação destes instrumentos atendendo ao número reduzido da amostra, são apresentados as suas características psicométricas na amostra estudada. Foram 4 as hipóteses testadas: a hipótese 1 previa diferenças significativas ao nível do género na adaptação psicossocial a curto prazo pós enfarte do miocárdio, apresentando as mulheres maiores dificuldades de adaptação que os homens; a hipótese 2 previa que a adaptação psicossocial a curto prazo fosse influenciada pelas representações de doença; a hipótese 3 previa a existência de diferenças significativas ao nível do género nas representações de doença pré alta e pós alta, apresentando as mulheres representações de doença mais negativas do que os homens nos três momentos; por último, a hipótese 4 previa que a adaptação psicossocial pós alta fosse influenciada pelos níveis de ansiedade e depressão pré alta. Dos resultados obtidos no teste de hipótese deste estudo, salientam-se a comprovação parcial da hipótese 1 em termos de adaptação funcional, verificando-se diferenças significativas ao nível do género nas sub-escalas locomoção e tarefas domésticas, apresentando as mulheres uma pior adaptação em ambas as dimensões. Ao nível da adaptação emocional, os resultados comprovam a hipótese 1, apresentando as mulheres níveis de ansiedade e depressão mais elevados ao longo dos 3 momentos de avaliação. Em termos da hipótese 2, os dados obtidos corroboram-na globalmente. Verificou-se que as representações de doença influenciam a adaptação psicossocial à doença em várias dimensões, sendo a representação emocional o predictor mais significativo. No entanto, é importante assinalar que há padrões diferenciais de predicção, segundo o momento de avaliação considerado. Ao nível da hipótese 3, os resultados encontrados confirmam a hipótese colocada para várias dimensões das representações de doença no sentido esperado. As mulheres apresentam representações de doença mais negativas nas sub-escalas identidade, duração aguda crónica, controlo tratamento, e coerência da doença. Finalmente, os dados obtidos na hipótese 4 confirmam parcialmente a hipótese testada. A ansiedade durante o internamento e na alta aparece como o predictor mais importante do estado emocional pós alta, assim como da adaptação funcional ao nível das emoções. As análises exploratórias efectuadas com variáveis clínicas revelam que a dor no peito sentida anteriormente, a classe Killip, e o tempo de internamento influenciam a adaptação psicossocial pós enfarte agudo do miocárdio, sendo de particular importância a sua identificação para promover a recuperação e a adaptação psicossocial em homens e mulheres. São discutidas as implicações destes dados para o desenvolvimento de estudos futuros e para a reabilitação cardíaca em Portugal. Estes dados piloto apontam para a necessidade de prestar atenção aos factores psicossociais na reabilitação cardíaca das mulheres pós enfarte agudo do miocárdio.This study is part of a larger study financed by the Science and Technology Foundation, POCTI 35749/99, “Psychosocial outcomes in rehabilitation following myocardial infarction in Scottish and Portuguese women: A cross-cultural comparison”. This investigation was done in a sub-sample of the larger study and adresses the short term psychosocial adaptation to an acute myocardial infarction and some of the variables used in the study mentioned above. Therefore the main aim of this investigation is to evaluate the differences that exist at the gender level, in the short term psychosocial adaptation process in patients with acute myocardial infarction. This study was conducted in a Portuguese sample of patients with acute myocardial infarction, from two central hospitals in the northern region (N = 78; 46 men and 32 women). It is a cohort study, with a longitudinal and correlational/ differential design, being the patients evaluated at three moments: two days after the hospital admission; at discharge from hospital (about seven days after admission); and two weeks after the discharge. This study is guided by the following aims: to analyse the differences between men and women, in terms of the short term psychosocial adaptation post acute myocardial; to describe the illness representations in patients with acute myocardial infarction and to compare them at the level gender, at the three evaluation moments; to explore the role of several socio-demographic and clinical variables in the short term psychosocial adaptation; to use the obtained results to generate guidelines for short term cardiac rehabilitation, considering gender. The evaluation instruments used were selected and adapted into Portuguese in the context of the project financed by FCT. To evaluate the functional adaptation the Sickness Impact Profile – SIP was used; the Hospital Anxiety and Depression Scale – HADS was used to evaluate emotional adaptation; the Illness Perception Questionnaire Revised – IPQ-R was used to evaluate illness representations. Given the fact that we have no knowledge of any studiesdone in our country regarding the evaluation of the psychometric characteristics of the HADS and SIP, and in spite of not being a major aim of this study the validation of these instruments, their psychometric characteristics in this sample are presented here. Four hypothesis were tested: Hypothesis 1 predicted significant differences at the gender level in the short term psychosocial adaptation after myocardial infarction, with women presenting more difficulties in adaptation than the men; Hypothesis 2 predicted that the short term psychosocial adaptation would be influenced by the illness representations; Hypothesis 3 predicted significant gender differences in the illness representations before and after discharge from hospital, with women presenting more negative illness representations than men at the three moments; Hypothesis 4 expected that the psychosocial adaptation after discharge from hospital would be influenced by the levels of anxiety and depression before discharge from hospital. From the results obtained in hypothesis testing, we highlight the partial confirmation of Hypothesis 1 since significant gender differences were found for the sub-scales ambulation and home management, with women presenting worse adaptation in both dimensions. At the levelemotional adjustment, the results confirm Hypothesis 1, as women presented higher levels of anxiety and depression during the three moments of evaluation. Concerning Hypothesis 2, the data supporte this hypothesis globaly indicating that the illness representations influence psychosocial adaptation to illness in several dimensions, being the emotional representation the most significant predictor. However, it is important to point out that there are differential patterns of prediction, according to the evaluation moment that is considered. Regarding Hypothesis 3, the results confirm the hypothesis for several dimensions of the illness representations in the expected direction. Women present more negative illness representations than men in the sub-scales identity, duration, treatment control, and illness coherence. Finally, the data obtained partially confirm Hypothesis 4. Anxiety during the hospital stay and at discharge from hospital appears as the most important predictor of the emotional status after discharge, as well as the functional adaptation at the emotion level. The exploratory analyses conducted with clinic variables reveal that prior chest, class Killip, and the duration of the hospital stay influence the psychosocial adaptation after the acute myocardial infarction, and their identification is important to promote the recovery and the psychosocial adaptation in men and women. The implications of these data are discussed in terms of the development of future studies and cardiac rehabilitation in Portugal. These pilot data point out the need to pay attention to psychosocial factors in cardiac rehabilitation of women after the acute myocardial infarction.Fundação para a Ciência e a Tecnologia - POCTI 35749/99

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved