Position Paper - Os Desafios da Reavaliação de Tecnologias de Saúde em Portugal

Introduction: The recently created Health Technology Assessment System (SiNATS) in Portugal will allow the reassessment of health technologies in a clinical practice context. This position paper intends to list and briefly describe the numerous challenges and limitations that may influence the premises and the Outcomes of the health technology reassessments and therefore its own purpose. This paper reflects the position adopted by the ISPOR Portugal Regional Chapter (International Society for Pharmacoeconomics and Outcomes Research – ISPOR Portugal) regarding this subject. Methods: A group of members of ISPOR Portugal reviewed the literature available, namely documents of international workgroups that have previously focused on similar matters, and conducted a critical analysis on the challenges faced by health technologies reassessment within the national context. A final revision of the paper was requested to all members of the ISPOR Portugal Regional Chapter. Results: Several limitations that may potentially compromise the reassessment of health technologies have been identified and thoroughly described, namely those with regard to the intervention itself (i.e. the health technology), the study population, the selection of the comparator and the Health Outcomes to consider in this type of analysis. The relevance of the information sources on which the investigation of comparative effectiveness may rely upon (at least to some extent) as well as the limitations and flaws inherent to it (i.e. bias and confounding factors) were also highlighted. Conclusions: A health technology reassessment system must be subject to an a priori analysis regarding its potentialities and limitations. In this paper these issues are addressed while taking SiNATS’s goals as reference points. Nevertheless, it is necessary to give continuity to this work, particularly through the creation of workgroups whose purpose is to study and analyse with greater detail the matters mentioned herein. Such work may, in fact, prove to be crucial for a successful implementation of a reassessment system that makes fair and efficient decisions on the funding of health technologies in Portugal

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Estudos Histologicos e de Ultrastrutura em Interaccoes de Coffea spp. e especies nao hospedeiras com Hemileia vastatrix, e de Coffea arabica com ferrugens nao patologicas

The histology and fine structure of some interactions of Coffee spp. and non hosts with Hemileia vastatrix, as well as of C. arabic with non-pathogenic rusts were studied. The pre-penetration stages of H. vastatrix were identical on susceptible (C. arabica) and resistant (C. arabic, C. congensis) coffees and on the non hosts Ixora javanica, Vigna unguiculata and Phaseolus vulgaris. Only in Archers hypogaea did the percentage of appressoria formed over the stomata was very reduced. The interactions of coffee and I. javanica with H. vastatrix, displayed post-historical resistance, whereas all the other interactions were pre-haustorial, being characterized by a limited growth of the fungus associated with alterations on the neighbour cell walls. These alterations were characterized by the deposition of lignin or similar compounds, callous and silica. The fine structure studies provided evidence that the post-haustorial resistance was associated in the early stages of infection to the death of the intercellular hyphae, haustoria and infected cells as well as to the encapsulation of haustoria with callous and cellulose. In the resistant coffees it was observed a strong degradation of the cell walls in contact with the hyphae, only evident in an advanced stage of infection and therefore not being apparently related with the resistanceAvailable from Fundacao para a Ciencia e a Tecnologia, Servico de Informacao e Documentacao, Av. D. Carlos I, 126, 1200 Lisboa / FCT - Fundação para o Ciência e a TecnologiaSIGLEPTPortuga

Career goals and internship quality among VET students

Given the increased self-directedness of todays' career environment, career goals represent to some extent the exercise of individual agency, particularly during ecological transitions (e.g., school to work). The main purpose of this study was to analyze the relationship between internship quality and career exploration behavior, considering students' career goals content (labor market vs. higher education). Using a longitudinal design (pre- and post-internship), we conducted a study (12th grade; N = 191) that explores the relationship between perceived qualities of the internship and the different dimensions of career exploration. Analysis of variance and analysis of covariance, with repeated measures, were used to analyze the data. The results reinforce the importance of career goals, since they seem to have a differentiating effect on how the quality of the internship interacts with students' career exploration behavior. Finally, the implications of these findings for career interventions and for future research in this area are discussed.info:eu-repo/semantics/publishedVersio

Phylogenetic analysis of Hemileia vastatrix and related taxa using a genome-scale approach

For more than a century, Coffee Leaf Rust caused by the biotrophic fungus Hemileia vastatrix, has increasingly stood out as one of the major factors hampering Arabica coffee production. Since its first historical outburst in the 19th century in Sri Lanka, this disease has rapidly spread worldwide and currently occurs in nearly all the regions of the world where coffee is grown. Despite its widespread distribution and negative economic impact, little is known about its evolutionary origin and phylogenetic placement in the fungal tree of life. Attaining this knowledge, however, would provide fundamental insights on the evolutionary context in which H. vastatrix emerged, which in turn could have important implications to understand the evolution of pathogenicity in this pathogen and in other rusts as well. With this in mind, we are undertaking a genomescale approach that will allow H. vastatrix and other rust fungi to be placed in the fungal tree of life with unprecedented detail by using complete proteomes of five Pucciniomycotina species, approximately 250 000 publicly available EST sequences from several Pucciniomycotina species and H. vastatrix’s recently obtained transcriptome. A high quality matrix that includes orthologs, co-orthologs and recent paralogs is currently being prepared with a sophisticated orthology detection strategy. On a first approach, we have been able to indentify at least 1040 single-copy orthologs that will be used for the phylogenetic analyses. Providing robust and resolved phylogenetic relationships will lay the ground for the identification of genes or gene families that are exclusive to H. vastatrix as well as genes of rapid evolution and/or subject of positive selection, which would be prime targets for functional studies aiming at disease control and prevention. This information will ultimately contribute significantly to advance our knowledge on H. vastatrix’s pathogenicity

Expression profiling of genes involved in the biotrophic colonisation of Coffea arabica leaves by Hemileia vastatrix

Coffee Leaf Rust, caused by Hemileia vastatrix, is the most important disease of Arabica coffee (Coffea arabica), which prompts studies aimed at understanding the genetic basis of this pathogen as well as its complex interaction with the host. In this work, 11 genes, putatively involved in signalling, establishment and maintenance of biotrophy (transport and metabolism), were characterised, and their expression profiles during host infection were assessed by RT-qPCR in three compatible coffee-rust interactions comprising two different rust races. The profiles of two chitin deacetylases (CD) and a heterotrimeric G-protein alpha subunit transcripts suggest that these enzymes are involved in host-pathogen recognition and establishment of biotrophy at early stages of infection, and the late expression of the CD1 gene was also recorded. Different expression profiles were observed for a MAP kinase gene between the two rust races, suggesting that this gene may be involved in the differentiation of infection structures in a race-specific pattern. Two amino acid transporters, an invertase, a hexose transporter and a mannitol dehydrogenase presented expression profiles similar to those reported in other rust fungi, indicating a fairly conserved genetic programme related to host infection in rust fungi. The strong upregulation of a Uromyces fabae rust transferred protein 1 orthologous gene was observed in H. vastatrix in planta structures, suggesting that this gene may also play a role during the establishment and the maintenance of biotrophy in coffee leaves. Overall, our results provide valuable insights to the current understanding of the biotrophic interaction between H. vastatrix - C. arabica at the molecular level and will contribute to a reasoned and sustainable use of resistant genotypes

Social representations of mothers about gestational hypertension and premature birth

OBJECTIVE: To identify the meanings attributed by mothers to hypertensive disorders of pregnancy (HDPs) and their consequences, such as premature birth and hospitalization of the infant in the neonatal intensive care unit (NICU). METHOD: A qualitative study, based on the Central Nucleus Theory, with 70 women who had hypertensive disorders of pregnancy and preterm delivery. We used the technique of free word association (FWAT) with three stimuli: high blood pressure during pregnancy, prematurity and NICU. RESULTS: We obtained 1007 evocations, distributed as follows: high blood pressure during pregnancy (335) prematurity (333) and NICU (339). These constituted three thematic units: representation of HDPs, prematurity and the NICU. The categories death and negative aspects were inherent to the three units analyzed, followed by coping strategies and needs for care present in HDPs and prematurity. CONCLUSION: The study had death as its central nucleus, and highlighted the subjective aspects present in the high risk pregnancy and postpartum cycle. It is hoped that this research will contribute to qualifying nursing care for women confronting the problem of HDPs, so that they can cope with less impacts from the adverse effects of high risk pregnancy and birth