11 research outputs found
Nationwide access to endovascular treatment for acute ischemic stroke in portugal
Publisher Copyright: Copyright Ordem dos M dicos 2021.Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Discussion: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitalspublishersversionpublishe
Acesso a Tratamento Endovascular para Acidente Vascular Cerebral Isquémico em Portugal
Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke
healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential
access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding
endovascular treatment in mainland Portugal and its administrative districts.
Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated
with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed
to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular
treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized
ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between
stroke onset, first-door, and puncture.
Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000
inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in
districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged
from 212 to 432 minutes, reflecting regional heterogeneity.
Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and
in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in
high-volume tertiary hospitals.Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos
cuidados de saúde em Portugal. Os nove centros que realizam tratamento endovascular não estão distribuídos equitativamente pelo
território, o que poderá causar acesso diferencial a tratamento. O principal objetivo deste estudo é realizar uma análise descritiva da
frequência e métricas temporais do tratamento endovascular em Portugal continental e seus distritos.
Material e Métodos: Estudo de coorte nacional multicêntrico, incluindo todos os doentes com acidente vascular cerebral isquémico
submetidos a tratamento endovascular em Portugal continental durante um período de dois anos (julho 2015 a junho 2017). Foram
colhidos dados demográficos, relacionados com o acidente vascular cerebral e variáveis do procedimento. Taxas de tratamento endovascular
brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e
cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas.
Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular
de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com
taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre
distritos variou entre 212 e 432 minutos.
Conclusão: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias
regionais no acesso. As métricas temporais foram comparáveis com as observadas nos ensaios clínicos piloto
Fine-scale foraging segregation in a green turtle (Chelonia mydas) feeding ground in the Bijagós archipelago, Guinea Bissau
Green turtles (Chelonia mydas) are highly dependent on neritic foraging areas
throughout much of their life. Still, knowledge of recruitment dynamics,
foraging habits, and habitat use in these areas is limited. Here, we evaluated
how the distribution and food preferences of green sea turtles from different
life stages varied within a foraging aggregation. We focused on two islands in
Guinea-Bissau, Unhocomo and Unhocomozinho, using water captures and
survey dives to record habitat use and characteristics, and stable isotopes to
infer diet. Additionally, we used stable isotopes to infer their diet. Two habitat
types were sampled: deeper (2.26 ± 0.4 m) rocky sites fringed by mangrove
with macroalgae, and sandy shallows (1.37 ± 0.12 m) surrounded by rocky reefs
with macroalgae and seagrass. The two benthic communities were similar
isotopically and in terms of species composition, except for the presence or
absence of seagrass, which had unique signatures. We captured 89 turtles
ranging from 35 cm to 97 cm in curved carapace length (i.e., juvenile to adult
stages). Size distribution was habitat-dependent, with most smaller turtles
present in sandy shallows and larger turtles favoring slightly deeper rocky
sites. Turtle isotopic signatures differed between the habitat of capture,
regardless of size, revealing a marked dichotomy in foraging preference. All
turtles fed primarily on macroalgae, mostly rhodophytes. However, individuals
captured in sandy habitats had evident seagrass skewed isotopic signatures.
Larger turtles may be unable to use the more diverse shallower foraging sites
due to increased vulnerability to predation. Despite the proximity of the
sampled foraging sites (2.7 km apart), the two foraging subgroups seem to
maintain consistently different feeding habits. Our study highlights how
heterogeneous green turtle foraging habits can be within populations, even at
small geographic scales.CITESinfo:eu-repo/semantics/publishedVersio
Sustainability Agenda for the Pantanal Wetland: Perspectives on a Collaborative Interface for Science, Policy, and Decision-Making
International audienceBuilding bridges between environmental and political agendas is essential nowadays in face of the increasing human pressure on natural environments, including wetlands. Wetlands provide critical ecosystem services for humanity and can generate a considerable direct or indirect income to the local communities. To meet many of the sustainable development goals, we need to move our trajectory from the current environmental destructive development to a wiser wetland use. The current article contain a proposed agenda for the Pantanal aiming the improvement of public policy for conservation in the Pantanal, one of the largest, most diverse, and continuous inland wetland in the world. We suggest and discuss a list of 11 essential interfaces between science, policy, and development in region linked to the proposed agenda. We believe that a functional science network can booster the collaborative capability to generate creative ideas and solutions to address the big challenges faced by the Pantanal wetland