protocol of a randomized trial

H4A Primary Healthcare Research Network scholars programme for support of research in the protocol design phase. This article will also be supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020).BACKGROUND: Screening with prostate-specific antigen (PSA) test for prostate cancer is considered a preference sensitive decision; meaning it does not only depend on what is best from a medical point of view, but also from a patient value standpoint. Decision aids are evidence-based tools which are shown to help people feel clearer about their values; therefore it has been advocated that decision aids should contain a specific values clarification method (VCM). VCMs may be either implicit or explicit, but the evidence concerning the best method is scarce. We aim to compare the perceived clarity of personal values in men considering PSA screening using decision aids with no VCM versus an implicit VCM versus an explicit VCM. METHODS: Male factory employees from an industrial facility in the Northern region of Portugal aged 50 to 69 years old will be randomly assigned to one of three decision aid groups used to support prostate cancer screening decisions: (i) decision aid with information only (control), (ii) decision aid with information plus an implicit VCM, (iii) decision aid with information plus an explicit VCM. Men will be allowed release time from work to attend a session at their workplace. After a brief oral presentation, those willing to participate in the study will fill the baseline questionnaire, plus a 5 point-Likert scale question about intentions to undergo screening, and will then receive the intervention materials to complete. We estimated a total sample size of 276 participants; with 92 in each group. The primary outcome will be the perceived clarity of personal values assessed by the Portuguese validated translation of the three subscales of the Decisional Conflict Scale. Secondary outcomes will be intention to be screened (before and after the intervention), the total score from the Decisional Conflict Scale and the self-report of having or not undergone screening at 6 months. DISCUSSION: This study will add to the body of evidence on the role of decision aids to support health preference-sensitive choices and provide further insight on the impact of different methods for eliciting people's values embedded within a decision aid. TRIAL REGISTRATION: NCT03988673 - clinicalTrials.gov (2019/06/17).publishersversionpublishe

Status assessment of the Critically Endangered Azores Bullfinch Pyrrhula murina

13 páginas, 4 figuras, 1 tabla.The Azores Bullfinch is endemic to the island of São Miguel (Azores, Portugal). Its status was uplisted to Critically Endangered in 2005 on the basis of an extremely small and declining population that was considered to be restricted to a very small mountain range (43 km2), in a single location, within which the spread of invasive plants constituted a threat to habitat quality. Nevertheless, information was mostly inferred, or the product of, non-systematic studies. In order to carry out a complete assessment of the conservation status we analysed: (i) population trend, calculated from annual monitoring 1991–2008, (ii) population size, and (iii) range size, obtaining estimates in a single morning study in 2008 involving the simultaneous participation of 48 observers. Contrary to previous inferences, the population is no longer decreasing, although quality of laurel forest habitat continues to decline due to the persistent threat of invasive species. Population size (mean ± SE) was estimated at 1,064 ± 304 individuals using distance sampling methods, although the estimate was very sensitive to the survey method used. Range size estimates (extent of occurrence and area of occupancy) were 144 km2 and 83 km2 respectively. Given the present information, we propose the downlisting of Azores Bullfinch to Endangered on the IUCN Red List.Este trabajo fue parte del programa "Azores Bullfinch monitoring" incluído en el proyecto de la Comisión Europea, LIFE NAT/P/000013 “Recovery of Azores Bullfinch’s habitat in the Special Protection Area of Pico da Vara / Ribeira do Guilherme”.Peer reviewe

An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing

Background: The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. Methods: The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded. Discussion: This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese National Health Service.publishersversionpublishe

Slashed Exponentiated Rayleigh Distribution

In this paper we introduce a new distribution for modeling positive data with high kurtosis. This distribution can be seen as an extension of the exponentiated Rayleigh distribution. This extension builds on the quotient of two independent random variables, one exponentiated Rayleigh in the numerator and Beta(q,1) in the denominator with q0. It is called the slashed exponentiated Rayleigh random variable. There is evidence that the distribution of this new variable can be more flexible in terms of modeling the kurtosis regarding the exponentiated Rayleigh distribution. The properties of this distribution are studied and the parameter estimates are calculated using the maximum likelihood method. An application with real data reveals good performance of this new distribution.En este trabajo presentamos una nueva distribución para modelizar datos positivos con alta curtosis. Esta distribución puede ser vista como una extensión de la distribución Rayleigh exponenciada. Esta extensión se construye en base al cuociente de dos variables aleatorias independientes, una Raileigh exponenciada en el numerador y una Beta(q; 1) en el denominador con q 0. La llamaremos variable aleatoria slash Rayleigh exponenciada. Hay evidencias que la distribución de esta nueva variable puede ser más flexible en términos de modelizar la curtosis respecto a la distribución Rayleigh exponenciada. Se estudian las propiedades de esta distribución y se calculan las estimaciones de los parámetros utilizando el método de máxima verosimilitud. Una aplicación con datos reales revela el buen rendimiento de esta nueva distribución

Bioactive and chemical properties of edible mycorrhizal mushrooms from Northeast Portugal

Mushrooms are widely appreciated all over the world for their nutritional properties1 and pharmacological value as sources of important bioactive compounds.2,3 Mycorrhizal macrofungi associate with plant roots constituting a symbiotic relationship, beneficial for both plant and fungus. In the present work five edible mycorrhizal species (Amanita caesarea, Cortinarius anomalus, Cortinarius violaceus, Lactarius volemus and Suillus luteus) from Northeast Portugal were studied for their bioactive and chemical properties. Antioxidant activity was accessed by in vitro assays: radical scavenging activity, reducing power, and lipid peroxidation inhibition. Bioactive compounds such as phenolic compounds, vitamins (ascorbic acid and tocopherols), sugars and fatty acids were obtained by high performance liquid chromatography (HPLC) or gas-chromatography (GC) coupled to different detectors. The main compounds identified in each class were: Phenolic compounds- protocatechuic, p-hydroxybenzoic and p-coumaric acids; Tocopherols- the four isoforms ,, and ; Sugars- mannitol and trehalose; Fatty acids- oleic acid (C18:1n9), linoleic acid (C18:2n6) and palmitic acid (C16:0). A similar profile of metabolites was observed in the studied mushroom species with the order sugars > fat > ascorbic acid > phenolic compounds > tocopherols. Nevertheless, the samples revealed different compositions: prevalence of sugars in Lactarius volemus (28.22 1.81 g/100 g dw), ascorbic acid (343.96 ± 30.98 mg/100 g) and phenolic compounds (8.68 ± 0.38 mg/100 g) in Cortinarius anomalus and fat (3.45 ± 0.65 g/100 g), tocopherols (449.76 ± 52.96 g/100 g) and antioxidant activity in Suillus luteus (EC50 values 1.92 ± 0.08, 0.75 ± 0.03, 0.61 ± 0.02 mg/ml for radical scavenging activity, reducing power, and lipid peroxidation inhibition, respectively)

Towards the antioxidant and chemical characterization of mycorrhizal mushrooms from Northeast Portugal

Mushrooms are widely appreciated all over the world for their nutritional properties and pharmacological value as sources of important bioactive compounds. Mycorrhizal macrofungi associate with plant roots constituting a symbiotic relationship. This symbiosis could influence the production of secondary metabolites, including bioactive compounds. We focused on the evaluation of antioxidant potential and chemical composition of mycorrhizal mushrooms species from Northeast Portugal: Amanita caesarea, Amanita muscaria, Amanita pantherina, Chroogomphus fulmineus, Cortinarius anomalus, Cortinarius collinitus, Cortinarius violaceus, Lactarius quietus, Lactarius volemus, Russula sardonia, Suillus luteus and Tricholoma ustale. A similar profile of metabolites was observed in the studied species with the order sugars > fat > ascorbic acid > phenolic compounds > tocopherols. Nevertheless, the samples revealed different compositions: prevalence of sugars in L. volemus, fat and ascorbic acid in A. muscaria, phenolic compounds in C. anomalus and tocopherols and antioxidant activity in S. luteus

Chemical composition and biological activity of different residues obtained from the wine industry

In recent years, the bioactive compounds present in agri-food sub-products have attracted increased attention due to their health benefits and advantages within a circular economy context. Annually, wine production is responsible for the production of large amounts of phytotoxic waste, which elimination is considered challenging since these residues can be hazardous to the environment when used as fertilizers or just discarded. Phenolic compounds are secondary metabolites processed by plants that have shown several health benefits, acting as antioxidants, antimicrobials, anticarcinogenic, or antidiabetics, among others. Bioactive phenolic molecules have attracted considerable attention from the pharmaceutical, cosmetic, and food industries. So far, several studies have been developed on the characterization of grape pomace and its components (seeds, skins, and stems), especially directed to the residues of red varieties.1 However, less attention has been paid to other by-products generated during winemaking, such as waste from the production of white wine, wine lees and diatomaceous earth. The latter is used in the filtration of wine and constitutes about 250 tons/year of waste from the wine sector in Portugal alone, making it a very pertinent residue with still scarce information being found in the literature. In this context, within the framework of the BacchusTech project that seeks to develop new innovative processes, comprising the extraction, purification, and concentration of bioactive compounds present in winemaking residues, different residues including pomace, lees and diatomaceous earth were evaluated for their chemical composition and bioactivities. Residues were extracted using an hydroalcoholic solvent (80%, v/v), total phenolic compounds were estimated using the Folin- Ciocalteu reagent and individual phenolic compounds were identified and quantified by liquid chromatography coupled to mass spectrophotometry (HPLC-DAD-ESI-MSn). Additionally, the biological activity was assessed through TBARS, DPPH, and reducing power assays to determine the antioxidant activity, and the antimicrobial activity was evaluated by broth microdilution against eight bacteria and two fungi. The phenolic composition was in accordance with the previously reported in red wines.2,3 Fifteen non-anthocyanin phenolic compounds were found, five phenolic acids (gallic acid and derivatives, p-hydroxybenzoic and p-coumaric acid), four flavan-3-ols (procyanidin dimers), two O-glycosylated flavanols (isorhamnetin and quercetin derivatives), three flavanol aglycones (quercetin, kaempferol, and myricetin), and one unknown compound. Regarding anthocyanins, five compounds were found, namely malvidin derivatives linked to acyl groups. Wine lees and white grape pomace before distillation presented the highest contents of phenolic compounds; however, only diatomaceous earth sample reveal the presence of O-glycosylated flavonoids. All samples showed antibacterial and antifungal activity against most of the tested microorganisms. The best bacteriostatic activity was evidenced by the red and white grape pomace before distillation and diatomaceous earth, while the wine lees stood out for their fungistatic activity. In general, all samples showed promising antioxidant capacity, with very good results being obtained on TBARS assay, particularly for the white pomace after distillation (EC50 = 0.016±0.002 mg/mL), diatomaceous earth (EC50 = 0.063±0.001 mg/mL) and red pomace before distillation (EC50 = 0.08±0.04 mg/mL). Overall, the results obtained showed that the residues analyzed are good sources of bioactive compounds, namely anthocyanins and other phenolic compounds, which can be used as raw materials for the steps of concentration, purification and/or isolation of compounds of added value.To Campelo for supplying the winemaking residues. To project “BacchusTech - Integrated Approach for the Valorization of Winemaking Residues” (POCI-01-0247-FEDER-069583). L. Barros, M.I. Dias, and S. Heleno (CEECIND/00831/2018) thank the national funding by FCT, P.I., through the institutional and individual scientific employment program-contract for their contract. Funding: This work was financially supported by the Competitiveness and Internationalization Operational Program (COMPETE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) and Foundation for Science and Technology (FCT, Portugal) through national funds FCT/MCTES to the CIMO (UIDB/00690/2020). The GIP-USAL is financially supported by the Spanish “Ministerio de Ciencia and Innovación” (PID2019-106167RB-I00) and “Junta de Castilla y León” (SA093P20 and CLU-2018-04).info:eu-repo/semantics/publishedVersio

Otimização da extração de ergosterol assistida por ultrassons a partir do cogumelo Agaricus bisporus L.

Os cogumelos são apreciados em todo o mundo, não só pelo seu valor nutricional, sabor apurado e textura, mas também pelas suas propriedades medicinais. Existem evidências científicas que demonstram os benefícios do consumo de cogumelos, que advém da sua riqueza em compostos bioativos, tais como micosteróis, e em particular, do ergosterol. Agaricus bisporus L. é o cogumelo mais consumido em todo o mundo, apresentando um elevado teor em ergosterol, cerca de 90% da sua fração de esteróis. Assim, este torna-se numa matriz muito interessante para a obtenção de ergosterol, uma molécula de elevado valor comercial. Segundo a literatura, o teor de ergosterol pode variar entre 3 e 9 mgporg de cogumelo seco. Atualmente, os métodos tradicionais tais como a maceração e a extração em Soxhlet estão a ser substituídos por metodologias emergentes, nomeadamente a extração assistida por ultrassons, visando diminuir a quantidade de solvente utilizado, o tempo de extração e, naturalmente, aumentar o rendimento da mesma. No presente trabalho, utitizou-se A. bisporus como fonte de ergosterol, tendo-se otimizado as condições mais favoráveis à sua extração utilizando a tecnologia de ultrassons variando o tipo solvente (hexano e etanol), a amplitude (50%, 75% e 100%) e o tempo (5 min, 10 min e 15 min). Além disso, e de forma a simplificar o processo, foi avaliada a pertinência da etapa de saponificação. O etanol demonstrou ser o melhor solvente, originando os rendimentos de ergosterol mais elevados (671, 5±0,5 mg/100 g de massa seca, com 75% de amplitude durante 15 min). Com hexano foi possível extrair apenas 152,2±0,2 mg/100 g, nas mesmas condições. No entanto, o extraio obtido com hexano mostrou ter uma pureza superior (11%) ao do extraio obtido com etanol (4%). No caso do extraio etanólico, o passo de saponificação aumentou consideravelmente a sua pureza, enquanto para o extraio obtido com hexano a pureza foi similar. Na verdade, o hexano apresenta maior setetividade para os compostos lipofílicos comparativamente com o etanol. Em geral, a extração assistida por ultrassons demonstrou ser uma tecnologia eficiente para maximizar o rendimento de extração em ergosterol. Outras tecnologias emergentes, tais como a extração assistida por micro-ondas, apresentam-se promissoras podendo originar também resultados promissores

Chemical characterization, antioxidant and antimicrobial activities of winemaking industry by-products

The exploitation of bioactive compounds trom agri-food by-products has been attracting an increasing interest from different industries within a circular economy context since several of compounds may have health properties or be used as natural colorants or preservatives. So far, several studies have been developed on the characterization of red wine grape pomace and its components (seeds, skins, and stems). However, less attention has been paid to other by-products, such as grape pomace from white wine, the residues after distillation, wine lees, and diatomaceous earth, the latter used in the filtration of wine and corresponding to about 250 tons/year of waste in Portugal. In this work, samples of these by-products were evaluated for their chemical composition by HPLC-DAD-ESI-Msn and bioactivities (antioxidant activity by TBARS, DPPH, and reducing power assays, and antimicrobial activity against eight bacteria and two fungi). Fifteen non-anthocyanin phenolic compounds were found, including 5 phenolic acids, 4 flavan-3-0Is, 2 0- glycosylated flavanols, 3 flavanol aglycones, and one unknown. In the red wine byproducts 12 anthocyanins were detected, most being malvidin derivatives. Wine lees and white grape pomace before distillation presented the highest contents of phenolic compounds. Ali samples showed antibacterial and antifunga! activity against most of the tested microorganisms, with red and white grape pomace and diatomaceous earth having the best bacteriostatic activity, while the lees stood out against fungi. Ali samples showed promising antioxidant capacity, with very good results obtained on TBARS for the white pomace after distillation and diatomaceous earth. Overall, the results show that besides grape pomace other wine industry byproducts are also good sources of bioactive compounds with high potential for exploitation.To Campelo for the winemaking residues. To projecl "BacchusTech - Inlegrated Approach for lhe Valorization of Winemaking Residues" (POCI-01-0247-FEDER-069583) and national funds FCT/MCTES to CIMO (UIDB/00690/2020). L. Barros, M. Dias, S. Heleno Ihank FCT, P.L, for Iheir scienlific employmenl program-contractinfo:eu-repo/semantics/publishedVersio

Phenolic, polysaccharidic and lipidic fractions of mushrooms from northeast Portugal: chemical compounds with antioxidant properties

Mushrooms do not constitute a significant portion of the human diet, but their consumption continues to increase due to their functional benefits and presence of bioactive compounds. Some of those compounds can be found in the phenolic, polysaccharidic and lipidic fractions of edible and inedible species. Herein, those fractions of five wild mushrooms (Coprinopsis atramentaria, Lactarius bertillonii, Lactarius vellereus, Rhodotus palmatus and Xerocomus chrysenteron) from Northeast Portugal were studied for their chemical composition and antioxidant properties. Protocatechuic, p-hydroxybenzoic, p-coumaric and cinnamic acids were found in the phenolic fraction, ramnose, xylose, fucose, arabinose, fructose, glucose, manose, mannitol, sucrose, maltose and trehalose were quantified in polysaccharidic fraction, linoleic and stearic (only in Lactarius sp.) acids, and β- and γ-tocopherols were the main compounds in the lipidic fraction. C. atramentaria and X. chrysenteron phenolic fractions gave the highest free radical scavenging activity, reducing properties and lipid peroxidation inhibition in brain homogenates, which is in agreement with its highest content in total phenolics. Furthermore, among the polysaccharidic fractions C. atramentaria also gave the highest antioxidant activity, which is accordingly with its highest total polysaccharides content and sugars obtained after hydrolysis.The authors are grateful to Fundação para a Ciência e a Tecnologia (FCT, Portugal) and COMPETE/QREN/EU (research project PTDC/AGR-ALI/110062/2009) for financial support. L. Barros (BPD/4609/2008) and S.A. Heleno (BD/70304/2010) also thank FCT, POPH-QREN and FSE. The GIP-USAL is financially supported by the Spanish Ministerio de Ciencia e Innovación through the Consolider-Ingenio 2010 Programme (FUN-C-FOOD, CSD2007-00063), and Junta de Castilla y León (Grupo de Investigación de Excelencia, GR133)