Men and women with chronic insomnia disorder and OSAS : different responses to CPAP

Objective: To evaluate the response to CPAP in patients with chronic insomnia disorder (CID) with OSAS in an unselected patient population including all OSAS severity groups. As a secondary objective, we also wanted to evaluate the differences between patients that improve insomnia symptoms with CPAP and patients that do not improve, specifically evaluating possible gender differences. Methods: Retrospective study of patients with a diagnosis of OSAS treated with CPAP and CID at the first clinical visit, selected from a database of an outpatient sleep clinic of University Hospital. Results: From a database of total of 827 patient, 90 patients were identified with OSAS and CID (53.3% women). Middle / moderate OSAS was diagnosed in 68.9% and severe OSA in 31.1%. Most patients (61.1%) improved insomnia symptoms after CPAP therapy. In the responders group, 58.2% had initial insomnia, 63.6% middle insomnia and 12.7% late insomnia. Responders to CPAP were more frequently women (women 61.8%, men 38.2%, p = 0.035) and there was no other difference between responders and non-responders. On subgroup analysis, this difference was significant only in severe OSAS (women 88.9%, men 31.6%, p = 0.013). Conclusion: In most patients with CID and OSA, there is a consistent reduction of insomnia symptoms with the CPAP use. This factor emphasizes the importance of performing PSG in CID. Insomnia in men with severe OSAS responds less frequently to CPAP suggesting that in these cases the insomnia phenotype is less dependent on the respiratory symptoms.info:eu-repo/semantics/publishedVersio

La formación de profesores: ¿formación continua o formación postgraduada? Perspectivas de profesores y de líderes de las escuelas

La formación es esencial para la adquisición de conocimientos específicos de la profesión docente. La investigación llevada a cabo tiene como problema central el impacto de la frecuencia de los cursos de post-grado en un número de maestros de primaria (EB) y educación secundaria (ES) de un Grupo de Escuelas[1] público y de un colegio privado en Portugal. Nuestro objetivo es entender si los profesores consideran esta formación como un valor añadido y en qué medida esto se refleja en la mejora de su desempeño profesional, de las escuelas y del aprendizaje de los estudiantes. Esta investigación de carácter cualitativo, orientada por un paradigma de investigación interpretativo, integra un estudio más amplio sobre el impacto de la formación postgraduada en educación. Se adoptaron diferentes procedimientos metodológicos que permitieron, a través de los datos obtenidos, comprender, cuestionar, discutir y reflexionar sobre las diferentes contribuciones de la formación postgraduada (FPG) y observar los efectos de estas formaciones en el desarrollo de competencias profesionales en distintas prácticas pedagógicas. Este artículo se centra en una discusión, informada por datos empíricos, de las perspectivas de los profesores que participaron en la FPG y de los directores de los centros educativos en que trabajan

The impact of graduate training on teachers and schools – two case studies: graduate teachers’ perceptions

The main goal of this study is to research the impact of enrolment in Graduate Programmes (GPs) on a set of Basic Education2 and High School3 teachers in Portugal. We seek to understand whether teachers consider this training as an added value, and the extent to which this is reflected in the improvement of their professional performance, in the schools, and in their students’ learning. Preliminary research results show, among other aspects, that the reasons why teachers enrol in GPs are associated mainly with personal fulfilment issues. Moreover, despite the fact that both teachers and school leaders recognize the importance of GPs, they acknowledge that there are still few effects.info:eu-repo/semantics/publishedVersio

The impacts of teachers’ post-graduate training in Portuguese schools

A investigação apresentada teve como problema central estudar o impacto da Formação Pós-Graduada (FPG) de professores do Ensino Básico (EB) e do Ensino Secundário (ES) em dois agrupamentos de escolas em Portugal. Procurámos entender se os professores assumem essa formação como um benefício e de que forma isso se manifesta na melhoria do seu desempenho profissional, das escolas e das aprendizagens dos alunos. Apresentámos, ainda, sugestões para potencializar os efeitos da FPG frequentada por professores.The main aim of the present study was to focus on the impact of post-graduation education on primary and secondary schoo teachers from two school clusters in Portugal. We sought to find out whether theses teachers perceive their post-graduation experience as an asset and how it is manifested in the improvement of their professional performance, of the respective school and pupils’ learning. We also presented suggestions to potentiate the effects of post-graduate training attended by teachers.info:eu-repo/semantics/publishedVersio

Seizures, electroencephalographic abnormalities, and outcome of ischemic stroke patients

© 2017 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial, and no modifications or adaptations are made.Objective: Seizures and electroencephalographic (EEG) abnormalities have been associated with unfavorable stroke functional outcome. However, this association may depend on clinical and imaging stroke severity. We set out to analyze whether epileptic seizures and early EEG abnormalities are predictors of stroke outcome after adjustment for age and clinical/imaging infarct severity. Methods: A prospective study was made on consecutive and previously independent acute stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 on admission and an acute anterior circulation ischemic lesion on brain imaging. All patients underwent standardized clinical and diagnostic assessment during admission and after discharge, and were followed for 12 months. Video-EEG (<60 min) was performed in the first 72 h. The Alberta Stroke Program Early CT Score quantified middle cerebral artery infarct size. The outcomes in this study were an unfavorable functional outcome (modified Rankin Scale [mRS] ≥ 3) and death (mRS = 6) at discharge and 12 months after stroke. Results: Unfavorable outcome at discharge was independently associated with NIHSS score (p = 0.001), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Unfavorable outcome 1 year after stroke was independently associated with age (p = 0.001), NIHSS score (p < 0.001), remote symptomatic seizures (p = 0.046), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Death in the first year after stroke was independently associated with age (p = 0.028), NIHSS score (p = 0.001), acute symptomatic seizures (p = 0.015), and EEG suppression (p = 0.019). Significance: Acute symptomatic seizures were independent predictors of vital outcome and remote symptomatic seizures of functional outcome in the first year after stroke. Therefore, their recognition and prevention strategies may be clinically relevant. Early EEG abnormalities were independent predictors and comparable to age and early clinical/imaging infarct severity in stroke functional outcome discrimination, reflecting the concept that EEG is a sensitive and robust method in the functional assessment of the brain.This work was supported by the 2012 Research Grant in Cerebrovascular Diseases (C.B.; scientific promoter: Sociedade Portuguesa do AVC; sponsor: Tecnifar).info:eu-repo/semantics/publishedVersio

Comparative complete scheme and booster effectiveness of COVID‐19 vaccines in preventing SARS‐CoV‐2 infections with SARS‐CoV‐2 Omicron (BA.1) and Delta (B.1.617.2) variants: A case–case study based on electronic health records

Background: Information on vaccine effectiveness in a context of novel variants of concern (VOC) emergence is of key importance to inform public health policies. This study aimed to estimate a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.617.2 and sub-lineages) VOC according to vaccination exposure (primary or booster). Methods: We developed a case–case study using data on RT-PCR SARS-CoV2-positive cases notified in Portugal during Weeks 49–51, 2021. To obtain measure of comparative vaccine effectiveness, we compared the odds of vaccination in Omicron cases versus Delta using logistic regression adjusted for age group, sex, region, week of diagnosis, and laboratory of origin. Results: Higher odds of vaccination were observed in cases infected by Omicron VOC compared with Delta VOC cases for both complete primary vaccination (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.8 to 2.4) and booster dose (OR = 5.2; 95% CI: 3.1 to 8.8), equivalent to reduction of vaccine effectiveness from 44.7% and 92.8%, observed against infection with Delta, to 6.0% (95% CI: 29.2% to 12.7%) and 62.7% (95% CI: 35.7% to 77.9%), observed against infection with Omicron, for complete primary vaccination and booster dose, respectively. Conclusion: Consistent reduction in vaccine-induced protection against infection with Omicron was observed. Complete primary vaccination may not be protective against SARS-CoV-2 infection in regions where Omicron variant is dominant.Grant no. 2021/PHF/23776; POCI-01-0145-FEDER-022184; Project ALG-D2-2021-06info:eu-repo/semantics/publishedVersio

LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol

Study ProtocolApproximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC’s burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The “Cardiovascular and respiratory events following COVID-19” component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The “Physical and mental symptoms following COVID-19” component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.This study is sponsored by Pfizer (grant code #68639655).info:eu-repo/semantics/publishedVersio

INSTRUMENTOS DE AVALIAÇÃO DA INCAPACIDADE E FUNCIONALIDADE DE TRABALHADORES COM DISTÚRBIOS MUSCULOESQUELÉTICOS RELACIONADOS AO TRABALHO: ANÁLISE DAS PROPOSTAS EXISTENTES

Trata-se de uma revisão da literatura sobre instrumentos de avaliação de incapacidade e funcionalidade de trabalhadores com Distúrbios Musculoesqueléticos (DME) com vista ao retorno ao trabalho em uma perspectiva biopsicossocial. Abrange o período de dez anos, com levantamento bibliográfico nas bases de dados do Pubmed, Scopus, Psycoinfo, CINAHL, utilizando palavras-chaves relacionadas a protocolos de avaliação de incapacidade e funcionalidade para trabalhadores com DME. Apenas oito artigos abordavam o tema de interesse. Os artigos foram analisados nas dimensões biomédica, psicossocial e relacionada ao trabalho. Foram identificados 23 instrumentos para avaliação de incapacidade. Dentre os instrumentos com itens em mais de uma dimensão, foram encontrados seis que incorporaram as dimensões biomédica e psicossocial, três com itens de todas as dimensões e apenas um instrumento com itens das dimensões psicossocial e relacionada ao trabalho. Essa revisão mostra que são escassos os relatos sobre a existência e uso de instrumentos validados que tratem das dimensões biomédica, psicossocial e relacionada ao trabalho.  Os instrumentos que utilizam uma abordagem compreensiva incluindo entrevista em profundidade e instrumentos validados podem ser um facilitador para o levantamento das demandas biopsicossociais do trabalhador doente

Comparative Effectiveness of COVID-19 Vaccines in Preventing Infections and Disease Progression from SARS-CoV-2 Omicron BA.5 and BA.2, Portugal

We estimated comparative primary and booster vaccine effectiveness (VE) of SARS-CoV-2 Omicron BA.5 and BA.2 lineages against infection and disease progression. During April-June 2022, we implemented a case-case and cohort study and classified lineages using whole-genome sequencing or spike gene target failure. For the case-case study, we estimated the adjusted odds ratios (aORs) of vaccination using a logistic regression. For the cohort study, we estimated VE against disease progression using a penalized logistic regression. We observed no reduced VE for primary (aOR 1.07 [95% CI 0.93-1.23]) or booster (aOR 0.96 [95% CI 0.84-1.09]) vaccination against BA.5 infection. Among BA.5 case-patients, booster VE against progression to hospitalization was lower than that among BA.2 case-patients (VE 77% [95% CI 49%-90%] vs. VE 93% [95% CI 86%-97%]). Although booster vaccination is less effective against BA.5 than against BA.2, it offers substantial protection against progression from BA.5 infection to severe disease.The acquisition of sequencing equipment and reagents used in this study by the Instituto Nacional de Saúde Doutor Ricardo Jorge was partially funded by the HERA project (grant no. 2021/PHF/23776) supported by the European Commission through the European Centre for Disease Control, and also partially funded by the GenomePT project (grant no. POCI-01-0145-FEDER-022184), supported by COMPETE 2020–Operational Programme for Competitiveness and Internationalisation, Lisboa Portugal Regional Operational Programme, Algarve Portugal Regional Operational, under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund, and by the Portuguese Science and Technology Foundation. Algarve Biomedical Center Laboratory received public funding through the Project ALG-D2-2021-06 Variants Screen in Southern Portugal– Monitoring Variants of Concern in Southern Portugal and the Portuguese Science and Technology Foundation national support through the Comprehensive Health Research Center (grant no. UIDP/04923/2020)info:eu-repo/semantics/publishedVersio

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.info:eu-repo/semantics/publishedVersio