Experiência profissionalizante na vertente de farmácia comunitária e investigação

Este trabalho encontra-se dividido em duas partes distintas. A primeira parte descreve o trabalho de investigação sobre fármacos anti-histamínicos H1, enquanto que a segunda parte incide sobre o relatório de estágio efetuado em Farmácia Comunitária. Capítulo I: Os anti-histamínicos H1 são o grupo de medicamentos mais utilizados no tratamento de doenças alérgicas. Estima-se que mais de 1,8 milhões de portugueses sejam utilizadores deste grupo terapêutico, o que representa mais de 22,0% da população de Portugal continental com idade igual ou superior a 15 anos. O principal objetivo desta investigação foi avaliar o perfil de utilização dos medicamentos anti-histamínicos H1, bem como possíveis efeitos adversos e interações medicamentosas. Para tal, foram aplicados questionários individuais a utentes de 9 Farmácias Comunitárias da Cova da Beira. A amostra foi constituída por 217 utentes voluntários que utilizaram anti-histamínicos H1 nos últimos 12 meses. Os dados foram recolhidos continuamente ao longo de três meses, entre fevereiro e maio de 2014, tendo sido posteriormente tratados estatisticamente com recurso ao software informático Statistical Package for the Social Sciences (SPSS) ? versão 22.0. Dos 217 utentes participantes, com idades compreendidas entre os 18 e os 85 anos, 146 (67,28%) eram mulheres. Os anti-histamínicos mais utilizados foram os de segunda geração, havendo predominantemente referência a medicamentos de marca. O Aerius® (Desloratadina) foi o medicamento mais utilizado, tendo sido mencionado por 53 indivíduos. A maioria (82,48%) dos inquiridos declarou obter o anti-histamínico mediante prescrição médica. Cerca de 40,09%, da população em estudo referiu reações adversas à toma do medicamento, sendo a sedação/sonolência a mais comum. Em relação ao consumo de álcool, 25,35% dos inquiridos afirmaram ter ingerido algum tipo de bebida alcoólica durante o tratamento com o anti-histamínico. Salienta-se também o facto de apenas 20 dos 217 inquiridos ter utilizado medicamentos pertencentes a grupos farmacológicos capazes de originar algum tipo de interação farmacológica com o anti-histamínico. Por último, apenas 22,12% dos inquiridos declararam usar algum tipo de produto ou suplemento natural. Capítulo II: A Farmácia Comunitária é um espaço de atuação farmacêutica, afirmando-se cada vez mais como uma unidade essencial ao funcionamento completo do Sistema de Saúde. O relatório de estágio tem por objetivo descrever todos os conhecimentos adquiridos, bem como as atividades desenvolvidas durante o estágio curricular, enfatizando o ato farmacêutico e tudo aquilo que o rodeia. O estágio curricular decorreu na Farmácia Sena Padez, no Fundão, entre 3 de Fevereiro e 20 de Junho de 2014.This document is divided into two chapters. The first one describes the investigation about antihistamine H1 drugs, whereas the second one focuses on the Community Pharmacy internship’s report. Chapter I: The antihistamines H1 are the most used medicines for treating allergies. It has been estimated that more than 1,8 million of Portuguese population uses this type of medicine, which represents more than 22,0% of the Continental Portugal population that is 15 or older. The main aim of this investigation was to evaluate the usage profile of antihistamines H1 medicines, as well as the possible side effects and drug interactions. In order to do this, individual questionnaires were applied to users of 9 different Community Pharmacies. The sample includes 217 voluntary users that used antihistamines H1 in the last 12 months. The data was collected during for 3 months, between February and May 2014, and were then statistically processed with the software Statistical Package for the Social Sciences (SPSS) ? version 22.0. On total, 146 (67,28%) of the 217 participants, between 15 and 85 years old, were women. The second generation antihistamines were the most used, and there was a preponderant reference of brand medicines. Aerius® (Desloratadine) was the most used medicine, mentioned in total by 53 people. The majority (82,48%) of people obtained the medicine under medical prescription. Around 40,09%, of the studied population referred adverse reactions to the medicine, with drowsiness/sedation as the most common reaction. Considering alcohol consumption, 25,35% of the interviewed people said having consumed some alcoholic drink during the treatment using the antihistamines. Equally important is the fact that only 20 of 217 questioned people used medicines of pharmacological groups that could cause some kind of drug interaction when taken with the antihistamine. Finally, only 21,12% of the respondents took some kind of natural product or supplement. Chapter II: Community Pharmacy is a place for pharmaceutical activity, asserting itself more and more as an essential unit for Health System’s operation. The internship report aims describing all the knowledge acquired, as all the activities developed during the curricular internship, highlighting the pharmaceutical activity and everything that is related to it. The curricular internship took place at Farmácia Sena Padez, in Fundão, between 3rd February and 20th June 2014

Estilos de vida e felicidade subjetiva de estudantes de cursos de especialização em enfermagem, em Angola

Os estilos de vida revelam-se como formas de pensar, de agir e de interação com o ambiente que rodeia cada pessoa individualmente, aparentandoum efeito positivo sobre a felicidade dos estudantes e sobre a forma como avaliam a sua vida. Conclui-se que os estudantes, participantes deste estudo, cuidam da sua segurança, despertam muito vespertinamente, preocupam-se em manter uma satisfatória imagem corporal e a saúde física e psicológica, são dedicados, assíduos e pontuais. Apesar de se preocuparem em beber água não fazem o número de refeições recomendadas e não fazem vigilância da saúde oral nem da pressão arterial

Morphological and Postural changes in the foot during pregnancy and puerperium : a longitudinal study

The aim of this study is to observe the morphological and postural changes to the foot that take place during pregnancy and the puerperium. Method: In this descriptive, observational, longitudinal study, we analysed 23 pregnant women, with particular attention to morphological and postural aspects of the foot, at three time points during and after pregnancy: in weeks 9-13 of gestation, weeks 32-35 of gestation and weeks 4-6 after delivery. The parameters considered were changes in foot length, the Foot Posture Index (FPI) and the Hernández Corvo Index, which were analysed using a pedigraph and taking into account the Body Mass Index (BMI). The same procedure was conducted in each review. Results: The statistical analyses obtained for each foot did not differ significantly between the three measurement times. A pronator-type footprint was most frequently observed during the third trimester of pregnancy; it was predominantly neutral during the postpartum period. Statistically significant differences between the measurement times were obtained in the right foot for cavus vs. neutral foot type (between the first and third trimesters and also between the first trimester and the puerperium) (in both cases, p < 0.0001). Conclusions: Foot length increases in the third trimester and returns to normal in the puerperium. According to FPI findings, the third trimester of pregnancy is characterised by pronation, while the posture returns to neutrality during the postpartum period. During pregnancy, the plantar arch flattens, and this persists during the puerperium. The incidence of cavus foot increases significantly in the third trimester and in the puerperium

Hábitos Alimentares das Pessoas com Diabetes Mellitus Tipo 2 em Portugal: Um Estudo Transversal

Introdução: A nutrição é uma área de intervenção na prevenção e gestão da diabetes mellitus; por isso, é fulcral promover a capacitação da população para a adoção de hábitos alimentares saudáveis. Ainda que existam alguns estudos nesta área, não se conhecem os principais erros nos hábitos alimentares das pessoas com diabetes em Portugal. Os objetivos deste estudo foram identificar os principais erros nos hábitos alimentares das pessoas com diabetes mellitus tipo 2 em Portugal e avaliar a sua relação com variáveis sociodemográficas. Métodos: Estudo transversal multicêntrico, em amostra de conveniência de pessoas com diabetes mellitus tipo 2 seguidas em Unidades de Cuidados de Saúde Primários. Aplicação do UK Diabetes and Diet Questionnaire (UKDDQ) – traduzido e adaptado, de julho a outubro de 2022. Análise estatística descritiva e inferencial. Resultados: Amostra de 550 participantes, 52,2% do sexo feminino, 68,3% com 65 anos ou mais, 55,8% com nível de escolaridade igual ou inferior ao 1.º ciclo do ensino básico, 24,7% com insuficiência económica e tempo desde o diagnóstico médio de 10,60 ± 8,13 anos. Apenas 36,2% da amostra obteve um score UKDDQ considerado saudável. Menos de 50% obteve scores saudáveis para os itens “arroz ou massa ricos em fibras”, “pão integral”, “manteiga, margarina e óleos vegetais” e “vegetais e leguminosas”. Somente 8,9% da amostra obteve score saudável para o consumo de fibras. Cerca de 70,4% obteve score saudável para o consumo de açúcares livres e 54,7% para o consumo de ácidos gordos saturados. Verificou-se a existência de uma correlação com significado estatístico positiva fraca entre o score UKDDQ e a idade (ρ = 0,201, p < 0,001), com escolha mais frequente de alimentos saudáveis com o aumentar da idade. As pessoas do sexo feminino reportaram hábitos alimentares mais saudáveis, particularmente no consumo de fibras e ácidos gordos saturados. Conclusão: A maior parte da nossa amostra não usufruiu do potencial efeito positivo de uma alimentação saudável. Individualizam-se grupos de alimentos cujos consumos devem ser enfatizados ou desencorajados, particularmente, a necessidade de incentivar o consumo de alimentos ricos em fibra. Ações educacionais dirigidas devem ter especial foco em pessoas mais jovens e/ou do sexo masculino

Feasibility of Brewer’s Spent Yeast Microcapsules as Targeted Oral Carriers

Brewer’s spent yeast (BSY) microcapsules have a complex network of cell-wall polysaccharides that are induced by brewing when compared to the baker’s yeast (Saccharomyces cerevisiae) microcapsules. These are rich in (β1→3)-glucans and covalently linked to (α1→4)- and (β1→4)-glucans in addition to residual mannoproteins. S. cerevisiae is often used as a drug delivery system due to its immunostimulatory potential conferred by the presence of (β1→3)-glucans. Similarly, BSY microcapsules could also be used in the encapsulation of compounds or drug delivery systems with the advantage of resisting digestion conferred by (β1→4)-glucans and promoting a broader immunomodulatory response. This work aims to study the feasibility of BSY microcapsules that are the result of alkali and subcritical water extraction processes, as oral carriers for food and biomedical applications by (1) evaluating the resistance of BSY microcapsules to in vitro digestion (IVD), (2) their recognition by the human Dectin-1 immune receptor after IVD, and (3) the recognition of IVD-solubilized material by different mammalian immune receptors. IVD digested 44–63% of the material, depending on the extraction process. The non-digested material, despite some visible agglutination and deformation of the microcapsules, preserved their spherical shape and was enriched in (β1→3)-glucans. These microcapsules were all recognized by the human Dectin-1 immune receptor. The digested material was differentially recognized by a variety of lectins of the immune system related to (β1→3)-glucans, glycogen, and mannans. These results show the potential of BSY microcapsules to be used as oral carriers for food and biomedical applications

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research