A new approach to explain the link between Social Support and Depression in a 2-years Arthritis Rheumatoid Sample. Is there any moderation effect of Acceptance?

Fundação para a Ciência e Tecnologi

Sublimação do vazio: a fragmentação da narrativa na vídeo-Arte

Mestrado em Criação Artística ContemporâneaA imagem de vídeo como time-based media partilha a linguagem e a morfologia do cinema e da televisão. No contexto da vídeo-instalação, este meio alterou a forma como o observador se relaciona com a imagemmovimento, explorando as noções de tempo (duração, velocidade, instantaneidade, raccord) e espaço (enquadramento, imersão, simultaneidade), que são condicionalismos inerentes ao meio. A vídeoinstalação joga permanentemente com conceitos como percepção, presença e ausência, espaço vivido e espaço da imagem, real e ficção, desmaterialização e imersão, reformulando o papel dos espaços institucionais de exposição (a galeria, o museu), numa estratégia de aproximação do observador à obra. Sendo um reflexo da própria condição pós-moderna, a vídeo-arte incorpora noções como a transitoriedade, a fragmentação, a repetição, a apropriação e a multiplicidade de narrativas. A introdução dos meios de pós-produção digital, nomeadamente das ferramentas de edição não-lineares, alterou a forma como se concebe e desenvolve a criação artística em vídeo, veiculando uma novanarrativa fragmentária e aberta.Video image as time-based media shares the language and morphology of cinema and television. In the context of video installation, this medium has changed the way the observer relates to the image-movement, exploring the concepts of time (duration, speed, immediacy, raccord) and space (framing, immersion, simultaneity), which are constraints inherent to the medium. The video installation permanently plays with concepts such as perception, presence and absence, lived space and image space, real and fiction, dematerialization and immersion, reshaping the role of the exhibitive institutions (the gallery, the museum), strategically approaching the observer to the work of art. Being a reflection of the postmodern condition itself, video art incorporates notions as transitivity, fragmentation, authorship, repetition and the multiplicity of narratives. The introduction of digital post-production, in particular of nonlinear editing tools, has changed the way artistic creation in video is conceived and developed, conveying a fragmentary and open new narrative

Avaliação económica de Fidaxomicina no tratamento de infeções por Clostridium difficile graves ou recorrentes

Objectives: Fidaxomicin is a macrocyclic antibiotic drug indicated for the treatment of Clostridium difficile infections (CDI). The purpose of this study was to evaluate from a societal perspective the cost-effectiveness and cost-utility of fidaxomicin in the treatment of severe or recurrent CDI compared to the recommended alternative therapy, vancomycin. Methods: The effectiveness estimates of fidaxomicin and vancomycin, provided by two clinical trials in addition to other studies, were extrapolated to 10 days cycles and a time horizon of 1 year using a Markov model. The costs considered in the study included medication, hospitalization, complications and outpatient visits. Estimates of the indirect costs generated by productivity losses due to absenteeism were not included, for lack of relevant evidence for the Portuguese reality and because the population affected by CDI tends to be no longer active in the labor market. Results: Over a one year horizon and compared to vancomycin treatment, in the base case, fidaxomicin treatment in patients with severe ICD is associated with a gain of 0.010 QALY and a cost increase of 138 €. The treatment of patients with recurrent CDI with fidaxomicin is associated with a gain of 0.019 QALYs and a cost reduction of 626 €. Fidaxomicin treatment has an acceptable incremental cost-utility ratio in patients with severe CDI (ICUR: 13,245 €/ QALY) and dominates in patients with recurrent CDI (ICUR: -33,701 €/ QALY). Fidaxomicin treatment in patients with severe and recurrent CDI is also associated with a reduction in the number of recurrences (ICER: 321 €/ recurrence avoided in patients with severe CDI and ICER: -828 €/ recurrence avoided in patients with recurrent CDI). These results are sensitive to the cost of hospitalization, decreasing with a rising cost of hospitalization. In the probabilistic sensitivity analysis the model predicts that the probability of cost-effectiveness of fidaxomicin is 44,9% in the case of severe CDI and 58% for recurrent CDI for a willingness to pay threshold of 30.000 €. Conclusions: In the Portuguese health system context, fidaxomicin presents good cost-effectiveness and cost-utility results, representing a valuable addition to the therapeutic arsenal for the treatment of CDI.Objetivos: A fidaxomicina é um antibiótico pertencente à classe macrocíclica de antibacterianos, com indicação para o tratamento de infeções por Clostridium difficile (ICD). O objetivo deste estudo foi avaliar, na perspetiva da sociedade, o custo-efetividade e o custo-utilidade da fidaxomicina no tratamento de ICD graves ou recorrentes, comparativamente à alternativa terapêutica recomendada, a vancomicina. Métodos: As estimativas de eficácia da fidaxomicina e vancomicina, provenientes de dois ensaios clínicos em conjunto com dados de outros estudos, foram extrapoladas para ciclos de dez dias e um horizonte temporal de um ano, recorrendo a um modelo de Markov. Os custos considerados no estudo incluem os custos da medicação, do internamento, das complicações e das consultas. Não foram considerados os custos indiretos derivados da perda da produtividade por absentismo, quer por falta de evidência direta relevante para a realidade portuguesa quer porque a população afetada pelas ICD tende maioritariamente a já não estar ativa no mercado de trabalho. Resultados: Ao longo de um ano, e comparativamente com tratamento com vancomicina, no cená- rio de base o tratamento com fidaxomicina em doentes com ICD grave está associado a um ganho de 0,010 AVAQ e a um incremento dos custos em € 138. No tratamento de doentes com ICD recorrente, a fidaxomicina está associada a um ganho de 0,019 AVAQ e a um decréscimo de custos de € 626. O tratamento com fidaxomicina corresponde assim a um valor aceitável de custo-efetividade em doentes com ICD grave (ICUR: € 13,245/AVAQ) e é dominante em doentes com ICD recorrente (ICUR: -€ 33,701/AVAQ). O tratamento com fidaxomicina em doentes com ICD grave e doentes com ICD recorrente está também associado a uma redução do número de recorrências (ICER: € 321/recorrência evitada em doentes com ICD grave e ICER: -€ 828/ recorrência evitada em doentes com ICD recorrente). Estes resultados são sensíveis ao custo do internamento, diminuindo com o aumento do custo do internamento. Na análise de sensibilidade probabilística, o modelo prevê que, para um limiar de aceitabilidade de € 30 mil, a probabilidade da fidaxomicina ser custo-efetiva é de 44,9 por cento no caso de ICD grave e de 58 por cento no caso de ICD recorrente. Conclusões: A fidaxomicina tem uma boa relação custo-utilidade no contexto do sistema de saúde português, representando um adicionamento importante ao arsenal terapêutico para o tratamento das ICD.info:eu-repo/semantics/publishedVersio

Validation of the psychometric properties of acceptance and action questionnaire-II in clinical and nonclinical groups of portuguese population

This study explores the factor structure of the Acceptance and Action Questionnaire (AAQ-II) in both clinical and general normative groups. It also examines the factorial invariance of a one-factor proposed model in both groups. Data was collected from the overall database of a Portuguese Cognitive and Behavioral Research Center (N= 687, 425 females; mean age= 36 years; SD= 11.33). Confirmatory Factor Analysis supported a one-factor structure with good internal consistencies and construct related validity. The one-factor solution was also supported with a second independent data set, which showed a configural, strict measurement and structural invariance of the one-factor solution proposed. Multigroup Confirmatory Factorial Analysis showed the configural invariance, weak measurement invariance and also structural invariance of the one-factor model of Acceptance and Action Questionnaire II across both groups under study. The one-factor model have both similar meanings and the same structure, but the measurement model in clinical and nonclinical groups was not the same. Toxic influences of experiencial avoidance as a core mechanism in the development and maintenance of several clinical disorders, may explain why the AAQ-II does not operate equivalently across clinical and nonclinical groups

PCV141 Atherosclerosis : real-world insights from a Portuguese primary care database

Copyright © 2019 Published by Elsevier Inc.Objectives: Cardiovascular disease remains the leading cause of death in Portugal and across the world. Atherosclerosis is the most common pathophysiologic process underlying CVD. Its clinical manifestations include coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral artery disease (PAD). This study aims to determine the clinical and demographic characteristics of adult patients with atherosclerosis in a Portuguese primary care comprehensive administrative database.info:eu-repo/semantics/publishedVersio

Obesity, acute kidney injury and mortality in patients with sepsis: a cohort analysis

Although the prognostic effect of obesity has been studied in critically ill patients its impact on outcomes of septic patients and its role as a risk factor for acute kidney injury (AKI) is not consensual. We aimed to analyze the impact of obesity on the occurrence of AKI and on in-hospital mortality in a cohort of critically ill septic patients. This study is retrospective including 456 adult patients with sepsis admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Obesity was defined as a body mass index of 30 kg/m2 or higher. The Kidney Disease Improving Global Outcomes classification was used to diagnose and classify patients developing AKI. AKI occurred in 87.5% of patients (19.5% with stage 1, 22.6% with stage 2 and 45.4% with stage 3). Obese patients developed AKI more frequently than non-obese patients (92.8% versus 85.5%, p = .035; unadjusted OR 2.2 (95% CI: 1.04-4.6), p = .039; adjusted OR 2.31 (95% CI: 1.07-5.02), p = .034). The percentage of obese patients, however, did not differ between AKI stages (stage 1, 25.1%; stage 2, 28.6%; stage 3, 15.4%; p = .145). There was no association between obesity and mortality (p = .739). Of note, when comparing AKI patients with or without obesity in terms of in-hospital mortality there were also no significant differences between those groups (38.4% versus 38.4%, p = .998). Obesity was associated with the occurrence of AKI in critically ill patients with sepsis; however, it was not associated with in-hospital mortality.info:eu-repo/semantics/publishedVersio

A aterosclerose nos cuidados de saúde primários: estudo da vida real

Introduction and Objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.Introdução e objetivos: caracterizar os doentes com aterosclerose, uma doença com elevado impacto socioeconómico, na Região de Saúde de Lisboa e Vale do Tejo. Métodos: Estudo observacional transversal, recorrendo ao Sistema de Informação desta Administração Regional de Saúde, com extração de dados clínico-demográficos e de consumo de recursos dos utilizadores adultos com aterosclerose em 2016. A aterosclerose foi definida pela presença de manifestações clínicas, fatores de risco aterotrombóticos e/ou consumo de medicamentos marcadores de aterosclerose. Foram comparados os resultados para a população com e sem manifestações clínicas (testes paramétricos). Resultados: Identificámos 318 692 utilizadores, a maioria (n=224 845 doentes; 71%) sem registo de manifestações clínicas. A subpopulação com manifestações clínicas era mais idosa (72,0±11,5 versus 71,3±11,0 anos), com maior proporção de homens (58,0% versus 45,9%), registo de hipertensão arterial (78,3% versus 73,5%), dislipidemia (55,8% versus 53,5%) e menor proporção de registo de obesidade (18,2% versus 20,8%), em comparação com a população sem manifestações clínicas (p<0,001). Os valores médios de pressão arterial sistólica/diastólica, C-C-LDL e hemoglobina glicada foram inferiores na subpopulação com manifestações (142/74 versus 146/76 mmHg, 101 versus 108 mg/dL, 6,80 versus 6,84%, respetivamente; p<0,001). Cada utilizador com aterosclerose realizou 4,1±2,9 consultas médicas presenciais e 8,6±10,0 painéis de análises clínicas, com diferenças nas subpopulações com e sem manifestações clínicas (4,4 ± 3,2 versus 4,0 ± 2,8 e 8,3 ± 10,3 versus 8,7±9,8, respetivamente; p<0,001). Conclusões: Cerca de um em cada três utilizadores adultos de cuidados de saúde primários com aterosclerose têm manifestações clínicas. Os resultados sugerem que o controlo dos factores de risco cardiovascular é sub-óptimo em doentes com aterosclerose.info:eu-repo/semantics/acceptedVersio

Cost and burden of non-small cell lung cancer's in Portugal

Copyright © 2014 Published by Elsevier Inc.Objectives: This study estimates the impact of Non-Small Cell Lung Cancer (NSCLC) on population health levels and its economic impact in Portugal in 2012.info:eu-repo/semantics/publishedVersio

Cost-effectiveness of sacubitril/valsartan for the treatment of patients with heart failure with reduced ejection fraction in Portugal

© 2019 Informa UK Limited, trading as Taylor & Francis GroupObjectives: This study assesses the cost-effectiveness of sacubitril/valsartan versus enalapril in patients with symptomatic heart failure with reduced ejection fraction (HFrEF). Methods: We used a previously developed Markov model calibrated with patient-level data from the PARADIGM-HF trial, adapted to the Portuguese setting. The model considers two health states (alive or dead) and uses regression analyzes to estimate hospitalizations and deaths over time. A panel of experts estimated resource consumption in the outpatient setting. To estimate resource consumption with hospitalizations, the National Health Service Diagnosis Related Groups database was used. Unit costs were based on national legislation, and on the Infomed database. The model considers a societal perspective, a time horizon of 30-years, and a 5% annual discount rate. Sensitivity analyses assessed the robustness of results. Results: Sacubitril/valsartan increases life expectancy by 0.5 life-years, corresponding to 0.4 incremental quality adjusted life-years (QALY) versus enalapril. The estimated incremental cost-effectiveness ratio (ICER) is 22,702€/QALY. Sensitivity analysis shows that results are robust, but sensitive to the parameter estimates of the cardiovascular survival curve. Conclusion: Sacubitril/valsartan is a cost-effective therapeutic option in the treatment of Portuguese patients with HFrEF and translate into significant health gains and increased life expectancy versus the current standard of care.This analysis was funded by Novartis Farma, Produtos Farmacêuticos SA.info:eu-repo/semantics/publishedVersio

Heterotrophic and photoautotrophic media optimization using response surface methodology for the Novel Microalga Chlorococcum amblystomatis

The nutritional requirements of novel microalgal strains are key for their effective cultivation and metabolite content. Therefore, the optimization of heterotrophic and photoautotrophic culture media is crucial for novel Chlorococcum amblystomatis growth. Heterotrophic and photoautotrophic biomass samples were characterized to identify the differences between their heterotrophic and photoautotrophic biomass composition and their biotechnological potential. Media optimization through surface response methodology led to 44.9 and 51.2% increments in C. amblystomatis-specific growth rates under heterotrophic and photoautotrophic growth, respectively. This microalga registered high protein content (61.49–73.45% dry weight), with the highest value being observed in the optimized photoautotrophic growth medium. The lipid fraction mainly constituted polyunsaturated fatty acids, ranging from 44.47 to 51.41% for total fatty acids (TFA) in cells under heterotrophy. However, these contents became significantly higher (70.46–72.82% TFA) in cultures cultivated under photoautotrophy. An interesting carotenoids content was achieved in the cultures grown in optimized photoautotrophic medium: 5.84 mg·g−1 β-carotene, 5.27 mg·g−1 lutein, 3.66 mg·g−1 neoxanthin, and 0.75 mg·g−1 violaxanthin. Therefore, C. amblystomatis demonstrated an interesting growth performance and nutritional profile for food supplements and feed products that might contribute to meeting the world’s nutritional demand.info:eu-repo/semantics/publishedVersio