ESSA - Resumos Indexados à WoS/Scopus
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- Biomonitoring of firefighters occupational exposure to polycyclic aromatic hydrocarbons during the 2014 hot seasonPublication . Oliveira, Mónica; Slezakova, Klara; Fernandes, Adília; Vaz, Josiana A.; Teixeira, João Paulo Fernandes; Delerue-Matos, Cristina; Pereira, Maria do Carmo; Morais, SimoneHuman biomonitoring is an important tool in environmental medicine that is used to assess the level of internal exposure to environmental pollutants. Firefighters are one of the most exposed and least studied occupations. During fire suppression, firefighters are heavily exposed to a wide range of chemicals. Polycyclic aromatic hydrocarbons (PAH) are ubiquitous environmental pollutants that are considered as the largest known group of carcinogens due to their cytotoxic and mutagenic properties. Smoke and ashes released during a fire are important sources of PAH. Firefighters can be also exposed to PAH through smoking, via polluted ambient air, water, soil, and through consumption of food. Metabolites of PAH (OH-PAHs), such as 1-hydroxynaphthalene (1OHNapt), 1-hydroxyacenaphthene(1OHAce), 1-hydroxypyrene (1OHPy) and 3-hydroxybenzo[a]pyrene (3OHB[a]P) have been used as biological markers for measurements of human internal exposure to PAH. The present work aims to quantify the urinary metabolites of PAH, namely 1OHNapt, 1OHAce, 1OHPy and 3OHB[a]P in study population of firefighters. Firemen exposed to fires that occurred during 2014 season were asked to fill a post-fire questionnaire and to collect urinary samples. A control study population group was selected to collect samples of urines during the pre-fires season (winter). Among all participating firemen only healthy no-smoking subjects were considered. OH-PAHs were analysed by high-performance liquid chromatography with fluorescence detection. Overall, 1OHNapt and 1OHAce were the most abundant OH-PAHs in firemen urine samples, accounting for approximately 90% of the total OH-PAHs. The urinary OH-PAHs in exposed firefighters were higher than those of control group. Data collected with the individual questionnaire were further used to analyse the concentrations of OH-PAH between (and within) control and exposed groups of firemen. Additionally, 1OHPy concentrations in the exposed firefighters will be compared with the available proposed guidelines.
- Cardiac rehabilitation and caregivers challenges a scoping reviewPublication . Loureiro, Maria; Parola, Vítor; Duarte, João; Oliveira, Isabel; Coutinho, Gonçalo; Martins, Maria Manuela; Novo, André; Delgado, BrunoMap the interventions directed to the caregiver of heart disease (HD)patients in cardiac rehabilitation programs (CRP) that promote their role and health. Scoping Review guided by the Joanna Briggs Institute method. Two independent reviewers assessed articles for relevance and extracted and synthesized data. Inclusion criteria comprised articles published in English, Spanish and Portuguese since 1950. The following databases were searched: CINAHL Complete (Via EBSCO); Medline (via PubMed); Scopus, PEDro, e Repositórios Científicos de Acesso Aberto de Portugal (RCAAP). From 351 articles retrieved, ten were included in the review. Different interventions were identified directed to the caregiver of HD patients: educational interventions and lifestyle changes, physical exercise, psychological interventions/stress management, and a category "Other" with training interventions in basic life support, elaboration of guidelines/recommendations and training for the role of caregiver. Regarding the population, heart failure patient caregivers are the primary intervention targets, followed by caregivers of patients with ischemic disease and integrated into CRP. Regarding the context, there is a concern that the professional intervention with the caregivers should be mainly at home (home-based), using face-to-face and telehealth monitoring, often combined, with references also to the hospital context, primary health care and rehabilitation center. Conclusions and implications for the clinical practice: It was found that most of the identified cardiac rehabilitation interventions are aimed at the dyad HD patient and caregiver/family. Including specific interventions targeting caregivers improves the caregiver’s health and empowers him/her. Patients care planning should include interventions specifically aimed at them that result into health gains for caregivers and patients, aiming at the quality of care.
- Contribution of red cell mass and UGT1A1 alleles in serum bilirubin levels of the portuguese populationPublication . Rodrigues, Carina; Costa, Elísio; Santos-Silva, Alice; Santos, Rosário; Bronze-da-Rocha, ElsaHepatic glucuronization of insoluble bilirubin is catalyzed by isoenzyme 1A1 of UDP-glucuronosyltransferase (UGT1A1), which is essential for efficient biliary excretion of bilirubin. The main cause of Gilbert syndrome (GS) in all populations studied to date is a TA duplication [(TA)7 allele] in the repetitive TATA-box sequence of the gene promoter, which normally consists of six TA repeats. However, this genetic polymorphism is not sufficient for the clinical phenotype of GS. By this reason, some studies have been performed to provide information about additional factors that could contribute to the pathogenesis of this disease. Recently, it was described that increased red cell mass probably plays a role in the pathogenesis of GS (Buyukasik et al. 2008 Am J Med Sci. 335,115-119). The aim of this work is to investigate the putative role of increased red cell mass and the (TA)7 allele in bilirubin serum levels, in the Portuguese population. This study was performed in 109 volunteer healthy young adults (20.3±1.9 years) without liver and/or hematological disorders, chronic infection, recent inflammation, malignancy, hemorrhage and medication. Blood samples were collected and processed in order to determine bilirubin serum levels, complete blood cells count, and DNA extraction. The TATA-box region was analyzed by PCR amplification followed by subsequent analysis by automated capillary electrophoresis. Among our population, 6 were homozygous for the (TA)7 allele, 55 were heterozygous and 48 were homozygous for the normal allele. One of the subjects was a compound heterozygous for the (TA)5 and (TA)7 alleles. Comparing the blood cells counts and the bilirubin serum levels according to the UGT1A1 genotype, we found statistically differences only in bilirubin levels [(TA)6/(TA)6: 0.49±0.20 mg/dL; (TA)6/(TA)7: 0.70±0.32 mg/dL; (TA)7/(TA)7: 1.10±0.74 mg/dL, p<0.05]. A positive statistically significant correlation (p<0.05) were found between bilirubin serum levels and haematocrit and mean cell volume. Our work showed that higher bilirubin serum levels are correlated with an increase red blood mass. However, no association was found between higher red blood mass and abnormal number of TA repeats in the promoter of UGT1A1 gene. This data suggests that in our population the presence of abnormal number of TA repeats in the UGT1A1 gene is associated with increased bilirubin levels but not with higher red blood mass, as previously described for GS patients.
- Contribution of red cell mass and UGT1A1 alleles in serum bilirubin levels of the portuguese populationPublication . Rodrigues, Carina; Costa, Elísio; Santos-Silva, Alice; Santos, M.R.; Bronze-da-Rocha, ElsaHepatic glucuronization of insoluble bilirubin is catalyzed by isoenzyme 1A1 of UDP-glucuronosyltransferase (UGT1A1), which is essential for efficient biliary excretion of bilirubin. The main cause of Gilbert syndrome (GS) in all populations studied to date is a TA duplication [(TA)7 allele] in the repetitive TATA-box sequence of the gene promoter, which normally consists of six TA repeats. However, this genetic polymorphism is not sufficient for the clinical phenotype of GS. By this reason, some studies have been performed to provide information about additional factors that could contribute to the pathogenesis of this disease. Recently, it was described that increased red cell mass probably plays a role in the pathogenesis of GS. The aim of this work is to investigate the putative role of increased red cell mass and the (TA)7 allele in bilirubin serum levels, in the Portuguese population. This study was performed in 109 volunteer healthy young adults (20.3 ± 1.9 years) without liver and/or hematological disorders, chronic infection, recent inflammation, malignancy, hemorrhage and medication. Blood samples were collected and processed in order to determine bilirubin serum levels, complete blood cells count, and DNA extraction. The TATA-box region was analyzed by PCR amplification followed by subsequent analysis by automated capillary electrophoresis. Among our population, 6 were homozygous for the (TA)7 allele, 55 were heterozygous and 48 were homozygous for the normal allele. One of the subjects was a compound heterozygous for the (TA)5 and (TA)7 alleles. Comparing the blood cells counts and the bilirubin serum levels according to the UGT1A1 genotype, we found statistically differences only in bilirubin levels [(TA)6/(TA)6: 0.49 ± 0.20 mg/dL; (TA)6/(TA)7: 0.70 ± 0.32 mg/dL; (TA)7/(TA)7: 1.10 ± 0.74 mg/dL, p<0.05]. A positive statistically significant correlation (p<0.05) were found between bilirubin serum levels and haematocrit and mean cell volume. Our work showed that higher bilirubin serum levels are correlated with an increase red blood mass. However, no association was found between higher red blood mass and the presence of abnormal number of TA repeats in the promoter of UGT1A1 gene. This data suggests that in our population the presence of abnormal number of TA repeats in the UGT1A1 gene is associated with increased bilirubin levels and that increased haematocrit and mean cell volume could contribute for this phenotype. Further studies comparing a larger group of GS patients, homozygous for the (TA)7) allele, are required to better understand the contribution of the red blood mass in the hiperlirubinemia.
- Effectiveness and reproducibility of an exercise training program: the ERIC-HF - multicenter randomized controlled trialPublication . Delgado, Bruno; Novo, André; Lopes, Ivo; Sousa, Luís; Klompstra, LeonieDecompensated Heart Failure patients are characterized by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, promoting functional capacity and increasing exercise tolerance. Little is known about the effectiveness and feasibility of it. The ERIC-HF program is an aerobic exercise training program developed for HF inpatients and includes cycloergometer training, walking and climbing stairs in order to promote patient’s functional capacity during the in-hospital stay period. Objective: To analyze the effect of an aerobic exercise training program (ERIC-HF)on exercise capacity of patients with decompensated heart failure. Secondary objectives were to assess the effects of an aerobic exercise training on functional independence and experience of dyspnea during activities of daily living. Design and setting: A randomised controlled clinical trial with follow-up at discharge. Eight different hospitals were included where patients with decompensated heart failure, admitted to the hospital, were randomly assigned to training (aerobic exercise program) or control (usual rehabilitation care guideline recommended). Patients were randomized (at a ratio of 1:1) to training group or control group using the software available online. After randomization, patients were clarified about the study and asked to provide informed consent. Patients were not informed about the group they were part of and no one declined participation. Only the investigators knew in which group patients were. The main outcome was exercise capacity, measured by 6-minute walking test at discharge. Other outcomes were the independence for the activitiers of daily living and the dyspnea associated to the activities of daily living. Results: 257 patients were included. The mean age of the patients was 67±11 years, 84% (n = 205) presented reduced ejection fraction and the in hospital stay average was 16±10 days. At discharge, patients in the ERIC-HF group walked further compared to the control group (278±117m vs 219±115m) and this difference stayed significant after correcting for confounders (p-value<0.001). A statistically significant difference was found favoring the ERIC-HF exercise group in functional independence (96±7 vs 93±12) and dyspnea associated to ADL (13±5 vs 17±7) and these differences stayed in correcting for baseline values and confounders (functional independence p-value=0.002; dyspnea associated to ADL p = 0.018). Conclusion: The ERIC-HF program is safe, feasible and an effective exercise program to increase exercise capacity and functional independence and to decrease dyspnea during ADL in in-hospital patients admitted due to decompensated HF.
- Equitable perinatal healthcare for migrants, Portugal: comparative analysis of a self-assessment toolPublication . Doetsch, Julia; Almendra, Ricardo; Carrapatoso, Mariana; Teixeira, Cristina; Barros, HenriqueMigration is seen as a common risk factor in obstetricmanagement. Migrants often have a higher risk of experience worse pregnancy outcomes, higher rates of operative delivery, and a higher likelihood to receive less adequate postpartum care when compared to native women. This study evaluates self-perceived assessment of migrant women and hospital directors on equitable migrant friendly perinatal healthcare quality and access during intrapartum and postpartum period at public maternity units across Portuguese mainland between 2017-2019. This cross-sectional study analyses perinatal health data from migrant women over 18 years giving birth in public maternity units from between April 2017 and March 2019 as part of the baMBINO project. Data on the assessments of maternity units’ directors on equitable migrant friendly healthcare was collected in a self-assessment tool. Two standards on healthcare access and on healthcare quality were developed by: 1) scoring 25 and 30 questions, respectively, from 0 (worst) to 5 (best); 2) calculating the average of each score. The OneSample Wilcoxon Test (non-parametric) was applied to compare the assessment of hospital directors with the migrant mothers and the Kruskal-Wallis one-way analysis of variance to test for regional differences. Significant differences between migrant woman and healthcare directors’ assessments on migrant friendly healthcare access and quality of care were found. Directors rated healthcare access with a median score of 2.4, twice as good as migrant women (1.3). Migrant women rated healthcare quality with a median score of 4.0 (directors: 3.2). Significant differences between the regions for quality of care and healthcare access were found. Statistically significant difference between migrants from Portuguese and non-Portuguese speaking countries was identified for healthcare access (p-value <0.001) and healthcare quality (p-value < 0.05).
- Exploring factors related to good exercise capacity in patients undergoing ERIC-HF programPublication . Delgado, Bruno; Klompstra, Leonie; Lopes, Ivo; Novo, AndréDecompensated Heart Failure (HF) patients are characterized by functional dependence and low exercise capacity. The factors associated to a good response to exercise are still unexplored. The ERIC-HF program is an aerobic exercise training program developed for HF inpatients and includes cycloergometer training, walking and climbing stairs in order to promote patient’s functional capacity during the in-hospital stay period. Purpose: to identify the factors related to good response to an aerobic exercise training program for decompensated heart failure (HF) patients. Methods: Cross-sectional study with 143 inpatients who performed the ERIC-HF program. Functional capacity was evaluated using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). A good response to the program was defined as a ≥ 300 meters distance at the 6MWT at discharge. Univariate analysis was performed between patients who walked 300 meters or more at the 6MWT and patients who walked less than 300meters, using Chi-square tests and Student’s T-test. Logistic regression analysis was performed to describe factors that were independently related to better functional capacity at discharge. Variables with a p-value smaller than 0.15 in the univariate analyses were entered into the logistic regression. A significance level at p <0.05 was assumed. The dependent variables were: 1) distance walked at the 6MWT, 2) the change between admission-to-discharge scores of BI and 3) LCADL. Independent variables were: 1) gender, 2) age, 3) number of exercise sessions, 4) number of days of in-hospital stay, 5) BIad, 6) LCADLad, 7) NYHA functional class, 8) left ventricular ejection fraction (LVEF) and 9) etiology. Results: The mean age of the patients was 67 (±10) years, 15.4% were NYHA class IV and 80% had reduced ejection fraction. The aetiology of HF was similar between ischaemic disease (32.9%) and valvular (33.6%). Patients presented a high level of impairment on FC. The majority were male (97; 67.8%), with an average of three CVRF and mostly sedentary, with only 17% performing regular physical activity. There was no significant difference between etiologies of HF. Comparison between the group of patients who walked 300meters or more, at the 6MWT, and patients who walked less than 300metrs, showed statistically significant differences in terms of gender, age, BI, LCADL, etiology of HF and LVEF. After logistic regression, age (p = 0.002), gender (p = 0.001) and BI (p<0.000) at admission showed to be statistically significant factors that affect the distance walked. Conclusions: The ERIC-EF programe appears to be more effective in male, younger patients and with low FC at admission. Apparently, reduced ejection fraction does not interfere with progression during the programe. Gender influences the performance of patients, since men presented with higher FC at discharge.
- Maternal care experience and postpartum depressive symptoms among migrant and native in PortugalPublication . Teixeira, Cristina; Santos, Susana; Guerra, João; Barros, HenriqueMigration is a risk factor for both, poor maternal experience with healthcare services (MEHCS) and postpartum depressive symptoms (PPDS), a matter of concern due to their adverse consequences. We aimed to assess the association between MEHCS and PPDS taking into account the migration status. Methods: This is part of a population-based study (baMBINO project), enrolling native (PT; n = 1568), permanent migrant (PM; n = 676) and temporary migrant (TM; n = 757) women recruited at delivery (2017-2019) in 32 Portuguese public hospitals. MEHCS was assessed based on 39 items of the Migrant Friendly Maternal Care Questionnaire asking about how women have experienced maternal care during pregnancy, during delivery and after birth. Items were grouped into 9 components each one assessing a different issue of MEHCS. For each component women were classified as having ‘‘good’’ or ‘‘less than good’’ experience. PPDS were assessed using the Edinburgh Postnatal Depression Scale (cut-off>12).Multivariate logistic regression model was fitted to estimate the association between MEHCS and PPDS. Adjusted odds ratio (aOR) and respective 95% confidence interval were obtained. Results: PPDS were reported by 3.8%, 5.8% and 8.2% of PT, PM and TM women, respectively (p < 0.001). After adjustment, 4 out 9 components of MEHCS appeared related with PPDS, such that women reporting less than good experience with ‘‘under standing information’’ (aOR = 1.72 95%CI:1.14-2.60), ‘‘decisions according to maternal wishes’’ (aOR = 1.56 95% CI:1.04-2.34), ‘‘time waiting for healthcare’’ (aOR = 1.50 95%CI:1.04-2.18) and ‘‘healthcare provider’s attitudes during pregnancy’’ (aOR = 1.58 95%CI:1.01-2.47) showed higher odds of PPDS than women reporting good experience. Conclusions: Further than the migration status, poor experience with some issues of maternal care seems play a role in the risk of PPDS Key messages: Awareness should be given to maternal care experience. Public health strategies should address factors underlying a positive maternal experience.
- Maternal near-miss and mortality associated with being referred: a case control study in LuandaPublication . Castelo, M; Campos, P; Magalhães, P; Teixeira, CristinaUnderstanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola.A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value <0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI).Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89).According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting.• Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola.• Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.
- Microbial water quality of public swimming pool in the district of BragançaPublication . Pires, Bruno; Afonso, Andrea Luísa Fernandes; Gonçalves, Cátia; Vieira, Joana; Afonso, Eugénia; Nogueira, António José M.; Teixeira, CristinaThe poor water quality of recreational and rehabilitation pools,has been correlated to insufficient disinfection or human contamination, and can be a vehicle for transmitting diseasesto users. Because people with different characteristics attendpublic swimming pools with different purposes, the pool water quality control is essential to minimize hazards related tounsafe water.MethodsThis study was based on data collection of 144 samples between 2018 and 2020 in therapeutic and recreational pools(indoor and outdoor) in the Braganca district. The proportionof the number of bathers were estimated, as well as the microbial parameters: Total coliforms,Escherichia coli, enterococci, Pseudomonas aeruginosa, total Staphylococcus,Staphylococcus coagulase-positive and mesophilic microbial count. Results: The E. coli, enterococci and mesophilic microbial count werenot found in any sample. Unsafe pool water was mainly contaminated by both photogenicP. aeruginosa(6.3%) and total Sthaphylococcus (10.4%). Levels ofP. aeruginosaintherapeutic pools was greater than in recreational pools (indoor and outdoor) (10.5% vs 6.8% and 4.5%, respectively),while total Sthaphylococcus was absent in therapeutic pools and represent 13.6% and 10.6% of positivity in indoor and outdoors wimming pools, respectively. The bathers number medium of therapeutic, indoor and outdoor pools was 4.8, 3.4 and 6.9,respectively. Conclusions: Overall, the results endorse the good water quality of theseswimming pools, mainly by the absent of faecally-derivedbacteria. The presence of P. aeruginosain therapeutic pools canbe explained by the type of users, while the high number of bathers may promote the growth of some microorganisms,particularly in outdoor pools