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- Childhood circumstances and mode of deliveryPublication . Teixeira, Cristina; Correia, Sofia; Barros, HenriqueObjective To assess the influence of social circumstances at 12 yrs on c-section delivery. Methods Women (n¼6827) were consecutively recruited during the assembling of a birth-cohort. Interviews were used to obtain data on social and demographic characteristics and current pregnancy events. Financial childhood circumstances were classified as low (LF) or high (HF) based on the number of amenities reported. Parents’ education was defined as low (#6 years, LPE) and high (HPE). The effect of participants’ financial socioeconomic conditions on csection risk was computed using logistic regression stratified by parents ‘education. Methods Women (n=6827) were consecutively recruited during the assembling of a birth-cohort. Interviews were used to obtain data on social and demographic characteristics and current pregnancy events. Financial childhood circumstances were classified as low (LF) or high (HF) based on the number of amenities reported. Parents' education was defined as low (≤6 years, LPE) and high (HPE). The effect of participants' financial socioeconomic conditions on c-section risk was computed using logistic regression stratified by parents ‘education. Results Women with both high financial and educational childhood circumstances were significantly older, more educated and more frequently primiparous, with normal or underweight and reporting private antenatal care. The overall c-section rate was 35.6% varying from 32.2% (LF-LE) to 41.3% (HF-HE). After adjustment and considering women in LF-LPE as reference, we obtained OR=0.92; 95% CI 0.66 to 1.28 for LF-HPE group, OR=1.19; 95% CI 1.04 to 1.37 for HF-LPE group and OR=1.38; 95% CI 1.16 to 1.64) for HF-HPE group. Stratifying by parents' education and compared with women in LF group, those in HF group showed higher risk of c-section either in the LPE group (OR=1.19; 95% CI 1.04 to 1.37) or in the HPE group (OR=1.42; 95% CI 0.99 to 2.02). Conclusions Our results suggest that, independently of the parents' education and the current socio-demographic conditions, the childhood financial environment may influence the mode of delivery.
- Co-existance of congenital red cell pyruvate kinase and band 3 deficiencyPublication . Branca, Rosa; Costa, Elísio; Rocha, Susana; Coelho, Henrique; Quintanilha, Alexandre; Cabeda, José; Santos-Silva, Alice; Barbot, José
- Effect of chaethomellic acid on renal function in rat model of chronic renal failurePublication . Nogueira, António José M.; Mega, Carmén; Fonte, Elizabete; Oliveira, Paula A.; Colaço, Bruno Jorge; López-Novoa, Jose; Colaço, Aura; Pires, Maria JoãoTo study the effect of chronic treatment with chaethomellic acid (CA), a highly specific inhibitor of ras farnesyl-protein transferase, on the renal function of rats with renal failure induced by renal mass reduction. Male Wistar rats were subjected to 5/6 nephrectomy (RMR) or sham-operated (SO). One week after surgery, rats have been placed in four experimental groups: RMR: rats without treat- ment (n=13); RMR+CA: rats treated with CA (n=13); SO: rats without treatment (n=13); SO+AC: rats treated with CA (n=13). CA was intraperitoneally administered in a dose of 0.23 g/Kg three times a week for 6 months. Creatinine, blood urea nitrogen (BUN) and protein were measured in serum and/or urine by routine laboratory techniques. BUN, creatinine, and proteinuria were significantly lower and creatinine clearance was significantly higher in SO and SO+AC groups when compared with RMR and RMR+AC groups. There were no differ- ences in creatinine, proteinuria and creatinine clearance between RMR and RMR+AC groups. Anyway, RMR+AC group showed significant lower BUN and lower creatinine and proteinuria, and higher creatinine clearance than RMR group. In a model of renal failure induced by RMR, 6 months of treatment with CA may have some beneficial effect on renal function.
- Effect of mode of delivery on early oral colonization and childhood dental caries: a systematic reviewPublication . Antão, Celeste; Teixeira, Cristina; Gomes, Maria JoséBackground: Oral colonization starts at birth by vertical transmission. Objective: To determine whether mode of delivery influences the oral colonization of infants and contributes to the risk of childhood dental caries. Methods: A systematic review was conducted in the electronic database Web of Science for articles published from January 1995 to December 2015 by using a set of keywords. Results: From 2,644 citations identified through electronic search, ten studies met the inclusion criteria. According to the studies mode of delivery influences oral microbial density, oral microbial profile and the timing of oral colonization by cariogenic microbiota. However, there are no consistent results concerning either the prevalence of children harboring cariogenic microbiota or the prevalence of early childhood caries by mode of delivery. Conclusion: Mode of delivery influences early oral colonization. However, it seems that other determinants rather than mode of delivery could be major contributors to the development of early childhood caries. Keywords: Early childhood caries, early oral colonization, acquisition of oral microflora, mode of delivery
- Effects of a strength exercise program during hemodialysisPublication . Novo, André; Domingues, Ânia; Preto, Leonel; Sousa, Tânia; Mendes, Eugénia; Baptista, Gorete; Vaz, Josiana A.Introduction and Aims: The present study aims to investigate the effects of an intradialytic program of strength exercises in patients with Chronic Kidney Disease. Individuals who undergo hemodialysis are faced with multiple catabolic processes, including protein and energy level, characterized by loss of muscle mass and decreased visceral proteins. Its pathophysiology becomes so complex, multifactorial and few explanations are encountered. However, it is clear that irregularities in muscle function, exercise performance and physical activity initiated in the early stages of CKD will progressively worsening. Methods: Of the 45 participants, 29 were randomly chosen to join the training group (TG) and 16 control group (CG). The TG conducted a program of strength training during hemodialysis sessions for 8 weeks, 3 times per week, while the CG remained with the usual routine. At the beginning of the program was conducted an assessment period: the Sit-to-Stand Test, the Up-and-Go Test, the Hand Grip Test, the Pinch Gauge© and anthropometric and laboratory tests, culminating in the application of SF-36 version 2. We repeated this evaluation procedure after completion of training protocol. Results: Taking into account the results obtained, the TG significantly increased the number of repetitions of the Sit-to-Stand Test (12,22±5,37 initials; 15,4±3,27 final), and improved runtime Up-and-Go Test (16,74±17,38s initials; 11,33±6,26s end). Regarding the right handgrip, this group improved significantly (18,79±11,32Kg/f initials; 21,92±11,73Kg/f end), not even checking the left side (18,5±11,60Kg/f initials; 18,46±11,63Kg/f final). As for digital right grip strength (5,68±2,14Kg/f initial; 6,04±2,88Kg/f end) and left (5,21±2,53Kg/f initial; 4,88±2,31Kg/f end) there is the same situation as in handgrip strength. After completion of training program, in TG the physical component of the SF-36 (version 2) improved significantly (34,178±10,83 initials; final 41,52±8,14), and the same happened with the mental component (51,43±7,33 initial; 52,74±8,47 final). Conclusions: It's visible an increase in the number of repetitions of the Sit-to-Stand Test in GT, declaring statistically significant changes. Through these results, it can be said that the program was beneficial, improving the ability of participants to perform a higher number of repetitions in comparison with the results obtained by many authors; It's clear that the GT had a reduction in the time of execution of the up and go test, with significant statistical differences. These values indicate an improvement in the physical condition of the patients. These results suggest that a program of strength training intradialytic improves functional capacity and quality of life in this debilitated population.
- Effects of an aerobic training in patients on hemodialysis programPublication . Novo, André; Sousa, Tânia; Anes, Eugénia; Domingues, Ânia; Mendes, Eugénia; Baptista, Gorete; Viana, JoãoIntroduction and Aims: The Chronic Kidney Disease and the hemodialysis treatment has significant potential in changing negatively the lifestyle of these patients, leading them to a reliance on health care and rehabilitation and, eventually, loss of social roles. Because of the changes mentioned, it's essential the implementation of strategies and programs for exercise training, designed to minimize many of the complications of this syndrome and consequently contribute to an improved quality of life. This research aims to evaluate the effects of aerobic training in hemodialysis patients with chronic renal disease. Methods: The study population was composed of 100 patients with Chronic Kidney Disease on regular hemodialysis program in the NorDial hemodialysis Unit, being offered to everyone the same opportunity to participate in the program training. Among those who expressed interest and willingness to participate, after application of the exclusion criteria and taking into account the patients choices, the result was a sample of 43 patients to integrate the Group Training (GT) and 16 patients to establish the Control Group (GC). The aerobic exercise program was implemented in early May of 2012 for 8 consecutive weeks, with a frequency of 3 sessions per week during the dialysis treatment. Before and after the intervention were executed the respective functional and physical assessments and the SF36-v2 questionnaire. Results: The training group is characterized by a mean age of 71.93±11.76 years and in hemodialysis 4.29±3.22 years, after the intervention had significant changes in hemoglobin levels of 11.02±0.88g/dL to 11.3±0.698g/dL and hematocrit of 32.55±2.62% to 33.59±1.9%. In the sit to stand test were observed changes in the number of repetitions of 13.24±4.96 to 18.08±6.23 and in the up and go the time to complete the test went from 15.03±10.90s to 9.67±5.74s. In the quality of life, the change was from 49.93±9.953 to 53.22±7.545 in the component related to mental health. Conclusions: The intradialytic aerobic training implemented had a beneficial effect on aerobic capacity/functional of these patients, as well on the perception of their quality of life, specifically in the component related to mental health. Further investigations are needed to determine the effects of this type of training on blood pressure, glucose and EPO dose administered.
- Empirical evaluation of the potential of low-cost and open source “on-the-person” ECG for cardiopathy pre-screeningPublication . Reis, Manuel José Cabral dos Santos; Silva, Hugo P.; Barros, Francisco; Ala, Sílvia Maria Fernandes; Sanfins, Víctor; Lourenço, Hélio B.M.Electrocardiographic (ECG) data analysis can reveal crucial information about the cardiovascular physiologi- cal phenomenon, which is modulated by the Autonomic Nervous System. Hereupon, beyond cardiovascular diagnosis, ECG markers can also reflect workload levels, or even physical and mental performance, through Heart Rate Variability (HRV) analysis. Building upon previous work found within the state-of-the-art, this pilot research explores the potential of using a low-cost device for cardiopathy pre-screening, through ECG signal analysis. With the aim of performing the rhythmical analysis, we performed empirical tests from a population of 21 control subjects in a resting position, and an additional 2 subjects, one of them in dynamic condition, in the scope of an exploratory research, using ECG wave segments analysis and HRV features extraction for nu- merical analysis. Results have demonstrated that the signal quality allows reliable ECG acquisition for further rhythmical and HRV analysis, in stationary and dynamic monitoring, for the bipolar leads applied. There was also evidence to suggest a benefit from including ECG morphological analysis with this hardware and software setup for prevention and diagnosis of cardiovascular disorders, although requiring further investigation.
- Exercise in patients admitted for decompensated heart failure - cardiac rehabilitationPublication . Delgado, Bruno; Novo, André; Gomes, BárbaraHeart failure (HF) is characterized by dyspnea, fatigue and edema that leads to decreased exercise tolerance, functional dependence and impairment of performance in activities of daily living (ADL). Exercise is a well stablish intervention, for patients with stable cronic HF, which leads to improvement of symptoms, promotes functional capacity and decrease exercise intolerance. Exercise its not yet tested for patients during the phase of stabilization. Purpose: To evaluate the safety and feasibility of an aerobic exercise training program for patients admitted due to decompensated HF: the ERIC program. Methods: Patients are randomized in training group (TG) or control (CG). Data includes cardiovascular history, HF history and two functional tools: London Chest of Daily Living Activities (LCADL) and Barthel Index (BI). TG patients perform the ERIC program twice a day, 6 days a week. ERIC program is a supervised aerobic exercise program, with increasing levels of intensity, divided into 5 stages: respiratory raining, gait training and climbing stairs, for progressive duration periods. In all sessions are valuated vital signs before and after the exercise, as well as Borg Modified Perceived Exertion scale. CG patients are supervised too and perform freely physical activity. At discharge, all patients perform a 6 minute walking test (6MWT), and evaluation of LCADL scale and BI. Results: Until now, 47 patients are randomized (24 in TG - 275 sessions) with an average age of 71 (11) years old. 31 are male, 80% are in NHYA class III and 20% are class IV. At admission both groups (training vs control) of patients have the same level of functional dependence. At discharge, TG present lower LCADL and Borg score and higher BI score. Those differences are statistically significant (p=0,038 LCADL; p=0,024 Barthel). The average distance on 6MWT by TG is 72 meters higher, which is a statistically significant (p=0,031). No adverse events had occurred, like precordial pain, falls or worsening of clinical state. Conclusions: ERIC program can safely lead patients to a better functional capacity state.
- Firefighters's occupational exposure to PM2.5 and polycyclic aromatic hydrocarbonsPublication . Oliveira, Beatriz; Slezakova, Klara; Pereira, Maria do Carmo; Fernandes, Adília; Vaz, Josiana A.; Delerue-Matos, Cristina; Morais, SimoneThis study collected the personal PM2.5 air fraction in fifteen healthy and no-smoking firefighters during their normal shift inside four Portuguese fire stations. Indoor PM2.5 levels varied between 0.05 to 1.04 µg/m3. Polycyclic Aromatic Hydrocarbons (PAHs) are known for their ubiquity and toxicity, being some of them classified as carcinogenic and possible carcinogens to humans. Firefighters’ personal PM2.5-bound total PAH concentrations ranged between 35.8 to 294 ng/m3 with total carcinogenic PAHs accounting with 12% to the total PAHs. Benzo[a]pyrene, the PAH biomarker of carcinogenicity, was detected in levels ranging from 6.74 × 10-2 to 1.00 ng/m3
- Frequência de acidentes de trabalho nos serviços de urgência dos Hospitais Portugueses entre 2000 e 2010Publication . Martins, Matilde; Barbiéri, Maria do Céu; Correia, Teresa I.G.O ambiente de trabalho hospitalar é caraterizado por agregar um conjunto de fatores de risco, que vão desde os físicos, aos químicos, aos biológicos e aos psicossociais, que expõem os seus trabalhadores a riscos acrescidos para a sua saúde, facilitando a ocorrência de acidentes de trabalho. Uva (2007); Martins, Silva e Correia (2012). Nos serviços de urgência/emergência, estes fatores são agravados. Os serviços de urgência/emergência são caracterizados por atenderem vítimas de doença súbita ou trauma em situação muitas vezes de risco de vida, que exige uma atuação rápida e recurso a tecnologia de ponta, favorecendo ou intensificando os riscos de acidentes de trabalho nestes profissionais. Os estudos nacionais e internacionais evidenciam o serviço de urgência como o segundo local com maior notificação de acidentes de trabalho. Ruiz, Barbosa e Zaida (2004); ACSS (2009); Martins, Silva e Correia (2012) Consideramos assim imperioso conhecer as condições em que ocorrem os acidentes de trabalho nestes serviços, as circunstâncias que os determinam e os influenciam, para deste modo produzir evidências que permitam, com segurança, intervir nas diferentes variáveis promovendo a saúde e prevenindo a doença nestes locais. Este estudo teve como objetivo analisar a notificação de acidentes de trabalho nos serviços de urgência de cinco unidades hospitalares portuguesas entre 2000 e 2010. Estudo epidemiológico transversal retrospetivo, referente ao período de 1 de janeiro de 2000 a 31 de dezembro de 2010. Realizado nos serviços de urgência de cinco hospitais portugueses, prestando assistência continua a utentes com diferente e diversos graus de complexidade. Todos os trabalhadores neste serviço fazem uma cobertura assistencial de 24 horas por dia de forma rotativa. Definiram-se como critérios de inclusão, trabalhar no serviço de urgência e ter acidente de trabalho notificado. A amostra foi constituída por 495 trabalhadores. A informação foi obtida recorrendo aos registos anónimos do inquérito de notificação dos acidentes de trabalho da Direção de Recursos Humanos da Saúde. A recolha de dados foi realizada, após autorização dos Conselhos de Administração das respetivas instituições, no período de janeiro a setembro de 2011, nos dias úteis entre as 9:00 e as 17:00 horas no serviço de recursos humanos/saúde ocupacional de cada instituição. Os dados foram codificados, inseridos e analisados em base de dados SPSS® (Statistical Package for Social Sciences) versão 18.0 para Windows. As medidas de frequência, neste estudo, foram calculadas tendo como população o total de acidentes notificados (459) nos cinco serviços de urgência. Do total de 3870 acidentes notificados, nos cinco hospitais, 495 (12,7%) foram nos serviços de urgência. Verificou-se um aumento da notificação de acidentes ao longo dos anos de (3,8%) em 2000 para (11,9%) em 2010. Estes resultados vão de encontro aos dados publicados pela Administração Central dos Serviços de Saúde que apontam para um aumento da taxa de acidentes notificados nas instituições de saúde entre 1997 e 2007 de aproximadamente 12%. Nestes serviços, a maior notificação de acidentes foi na categoria profissional dos enfermeiros (50,9%) seguida da categoria dos auxiliares de ação médica (34,3%), no género feminino (76,6%), no grupo etário de 20-29 anos (34,4%) e com mais de 10 anos de serviço (38,8%). Dados corroborados por outros estudos nesta área de especialidade. Nishide, Benatti e Alexandre (2004); Barbosa, Figueiredo e Paes (2009); Martins, Silva e Correia (2012). Os enfermeiros são os profissionais mais representativos na equipe, que prestam a maior parte dos cuidados diretos, de forma ininterrupta, recorrendo a tecnologia sofisticada, em situações de emergência, e stress. A existência de maior notificação de acidentes no grupo etário mais jovem pode dever-se ao facto de nos serviços de urgência as equipes serem maioritariamente jovens, precisamente pela dinâmica de trabalho que estes serviços incutem. Em trabalhadores com nível habilitacional de licenciatura (60,9%), com relação jurídica de emprego de nomeação (60%) e a praticar horário por turnos (87,7%). A maior frequência de acidentes notificados verificou-se nas três primeiras de trabalho (39,2%) e nos dois primeiros dias de trabalho após descanso semanal (55,5%). Em média os acidentes ocorreram às 13 horas (dp= +/- 5,7 horas), com prevalência às segundas-feiras (17,8%) e com uma distribuição mais ou menos homogénea ao longo dos anos. Dados também corroborados por outros estudos, que referem uma maior frequência de acidentes no início do turno de trabalho, por ser neste período que recai uma grande intensidade de trabalho e pela inadaptabilidade do trabalhador no primeiro dia e nas primeiras horas. Ruiz, Barbosa e Zaida (2004); Barbosa, Figueiredo e Paes (2009); Martins, Silva e Correia (2012). As principais causas foram a picada de agulha (48,9%), seguida dos cortes/pancadas (14,4%) e dos esforços excessivos/movimentos inadequados (13,5%), provocados por ferramentas/instrumentos (58%) e pela mobilização de doentes (11,7%). Vários estudos identificam como a principal causa de acidente em meio hospitalar a picada de agulha, facto que se prende com o tipo e frequência de procedimentos realizados neste contexto, como punçoes venosas, pesquisas de glicémia, colheita de sangue, preparação e administração de terapêutica, realização de pensos, realização de cirurgias, entre outros. Nishide, Benatti e Alexandre (2004); Izidoro, Iwamoto e Camargo (2010); Silva, Machado, Santos e Marziale (2011); Martins, Silva e Correia (2012). A parte do corpo mais atingida foi as mãos (58,8%) seguida do tronco (11,3%) e o tipo de lesão mais frequente foram as feridas (56,6%), os entorses/distensões (13,5%) e as contusões/esmagamentos (12,1%). Resultaram em incapacidade (22,4%) e o número de dias perdidos variou entre o mínimo de 1 dia e o máximo de 259 dias num total de 3 970, recaindo a média por acidente em 8 dias. O número de dias perdido correlacionou-se, através da correlação de pearson, positiva e significativamente com o grupo profissional, considerando o grupo profissional mais qualificado nos primeiros níveis, com o tempo de serviço, com o grupo etário, com o agente da lesão e tipo de lesão. E negativamente com o nível habilitacional, o numero de dias face ao descanso semanal. O que quer dizer, que os acidentes mais graves ocorrem preferencialmente nas categorias profissionais menos qualificadas e especializadas, com mais tempo de serviço e com idade mais avançada. Estes grupos profissionais além da exposição aos riscos caraterísticos do ambiente hospitalar, acrescem outros, como, sobrecarga de trabalho, salários insuficientes, formação inadequada, insatisfação e insegurança ocupacional. Os nossos dados corroboram os resultados dos estudos de Ruiz e Izidoro que referem que são frequentes e mais graves os acidentes que envolvem trabalhadores que auferem menores salários, como auxiliares de ação médica, trabalhadores de lavandaria, cozinha ou de serviços de apoio. Ruiz, Barbosa e Zaida (2004) e Izidoro, Iwamoto e Camargo (2010) Este estudo possibilitou identificar os acidentes de trabalho registados nos serviços de urgência de cinco unidades hospitalares portuguesas, verificando-se um aumento da notificação ao longo dos anos. O grupo profissional onde se verificou maior notificação foi o dos enfermeiros e no grupo etário mais jovem. A principal causa de notificação foi a picada de agulha e a parte do corpo atingida as mãos. No entanto os acidentes mais graves relacionaram-se com as auxiliares de ação médica e com o grupo etário com idades mais avançadas. Parecem-nos necessárias mudanças no ambiente de trabalho e a implementação de programas de prevenção, dirigidos a estes grupos específicos, para minimizar os acidentes e as suas consequências em ambiente de urgência/emergência.