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- Relevance of iron content for Escherichia coli growth in drinking waterPublication . Afonso, Andrea Luísa Fernandes; Pires, Bruno; Gonçalves, Cátia; Teixeira, Cristina; Nogueira, António José M.The chemical and microbiological quality of drinking-water should be considered within overall public health priorities. The chemical contaminants of drinking-water may have different sources, including agricultural activities (e.g. nitrate), geological origin, and as a result of corrosion reactions in the distribution systems (e.g. heavy metals) [1]. In public water system of drinking water, the presence of iron (Fe) could be related to increased bacterial activity including Escherichia coli growth [2,3], an indicator of faecal contamination and the potential presence of pathogenic bacteria, protozoa or viruses [1]. On the other hand, phylogenetically different species of bacteria can promote the oxidation of ferrous iron [Fe(II)] coupled to nitrate (NO3 -) reduction, often referred to as nitrate-dependent iron oxidation [4]. Aim: This research evaluated the relation between the iron (μg/L) and nitrate (mg/L) concentration and the E. coli colony-forming units (CFUs) persistence in drinking water distribution systems. Methods: The samples of drinking water (n=464) were analyzed according the standardized protocols [5]. The proportion of samples with high number of E.coli CFUs (>80) were estimated according to the concentration of iron (<50 or >=50 μg/L) and nitrates (<1 or >=1 mg/L). By including only positive samples for E.coli (n=22), we estimated the Spearman’s correlation coefficients (rs) and the respective p-value (p < 0.05) between iron concentration, nitrate concentration and number of E. coli CFU. Results: There were higher proportion of >80 E.coli CFUs among samples with high iron concentration (p=0.049) while no significant differences were observed by nitrate concentration (p=0.059). When analyses were restricted to positive samples for E.coli (CFUs > 0) we observed a significant correlation between iron concentration and E. coli CFUs; rs=0.497 (p=0.019), while no correlation was observed between nitrate concentration and E. coli CFUs; rs=0.335 (p=0.126). Conclusion: The results emphasizes the iron role in the E. coli persistence in drinking water of public network, rising some concerns in the field of public health
- The impact of oral health on quality of life in type-2 diabetic older people from inland Northern PortugalPublication . Paçô, Maria Teresa Lavandeira de Araújo Pimenta; Gomes, Maria José; Teixeira, CristinaThe assessment of the relationship between oral health and quality of life (OHRQOL) is crucial to planning oral health care programs but there is paucity in research on such relationship among people with poor oral health. Objectives: To assess the OHRQOL among older diabetic people from inland Northern Portugal. A cross-sectional study was carried out among 250 type-2 diabetic individuals aged 65 years or more; 54% being female. Data collection included clinical examinations and structured interviews. The OHRQOL was assessed by using the OHIP-14 questionnaire (scale ranged from 0 to 56; higher scores indicating poorer OHRQOL). Multiple linear regression analyses were conducted separately by gender, using OHIP-14 score as dependent variable and oral health parameters (dry mouth, gengival bleeding, periodontal pockets, number of natural anterior and posterior teeth and prosthodontic rehabilitation) as explanatory variables. Multiple standardized regression coefficients (b) were obtained for variables that kept in the model through a stepwise procedure. Clinical examination revealed that women had poorer oral health than men. OHIP-14 score was significantly higher among women than among men (28.3 ± 13.30 vs 20.8 ± 12.28; p = < 0.001) Multiple regression analysis in male group showed that number of natural posterior teeth (β = -0.428; p < 0.001) and dry mouth (β = 0.225; p = 0.020) had significant association with OHIP-14 score. In female group there were no oral factors significantly associated with such score. Conclusions: The OHRQOL showed a different pattern by gender. Among men the number of natural posterior teeth had impact on OHRQOL, highligthing the importance of strategies in perserving natural teeth throughout lifetime.
- Saúde mental dos estudantes do ensino superior em época pandémicaPublication . Galvão, Ana Maria; Teixeira, Cristina; Rodrigues, CarinaAssociado à pandemia COVID-19, desenvolve-se uma nova crise socioeconómica que, inevitavelmente, afeta a saúde mental dos portugueses. No início do ano 2021, devido ao aumento dos casos de infeção COVID-19, a população portuguesa entra num segundo confinamento e é sujeita ao dever de recolhimento domiciliário, mantendo as escolas com o ensino presencial. Com o agravamento da situação, a 23 de janeiro, o ensino voltou à modalidade à distância
- Incidence and mortality due to cervical cancer in 4 south European countriesPublication . Teixeira, Cristina; Afonso, Ana Cristina; Rodrigues, Luciana; Madureira, Muriela; Nogueira, António José M.To describe variation in incidence and mortality rates of cervical cancer (CC), between 4 Southern European countries that share similar cultural characteristics. Methods: Data on CC incidence and mortality reported in Portugal, Spain, Italy, and Greece for the year 2012 were obtained through the International Agency of Research on Cancer. Expected numbers of incident cases and deaths were obtained based on age-specific rates in European region. Standardized incidence rate (SIR) and standardized mortality rate (SMR) and respective 95% confidence interval (95% CI) were computed for each country by age group (15–39, 40–54, 55–64, and ≥65 years old). Results: The number of incident cases of and deaths due to CC observed in Greece, Italy, and Spain were significantly lower than expected, whichever the age group. In Portugal such pattern was, however, only found for incident cases among women aged up to 54 years. The number of incident cases observed in Portugal did not differ from that expected among women aged 55 to 64 (SIR = 90.8; 95% CI: 76.8–106.7) and aged 65 or more years (SIR = 110.0; 95% CI: 95.9–125.0). Also, the number of deaths observed in Portugal did not differ from that expected among women aged 15 to 39 (SMR = 70.0; 95% CI: 43.3–100.8), 40 to 54 (SMR = 93.6; 95% CI: 74.9–115.4), and 55 to 64 years (SMR = 93.6; 95% CI: 73.4–117.7) but was significantly higher than that expected among women aged 65 or more years (SMR = 126.7; 95% CI: 110.1–144.4). Conclusions: There is variability in CC incidence and mortality between 4 South European countries. To understand the reasons underlying such variability could improve approach to preventive care.
- Differences by gender in barthel index change after stroke: a retrospective study in the Northeast PortugalPublication . Gomes, Maria José; Teixeira, Cristina; Banrezes, SusanaForeseeing functional recovery after stroke plays a crucial role in planning rehabilitation programs. Objectives: To assess differences over time in functional recovery assessed through the Barthel Index (BI) rate of change (BIRC) between admission and discharge in stroke patients. Methods: This is a retrospective hospital-based study of consecutive patients with acute stroke admitted to a hospital in the Northeast Portugal between 2010 and 2014. BIRC was computed as the difference between the admission and discharge BI scores divided by time in days between these assessments. General linear model analysis stratiied by gender was used to know whether there was an increase in BIRC during time period under study. Adjusted regression coeficients and respective 95% conidence interval (95%CI) were obtained. Results: From 483 patients included in this analysis 59% (n = 285) were male. Among women, mean BIRC was 1.8 (± 1.88) units/ day in 2010 and reached 3.7 (± 2.80) units/day in 2014. Among men the mean BIRC in 2010 and in 2014 were similar being 3.2 (± 3.19) and 3.1 (± 3.31) units/day, respectively. After adjustment for age, BI at admission, type and laterality of stroke we observed an increase in BIRC over time among women such that mean BIRC in 2014 was 0.82 (95%: 0.48; 3.69) units higher than the one observed in 2010. No such increase in BIRC over time was observed among men. Conclusions: We observed an improvement in functional recovery after stroke but only among women. Our results suggest differences over time in clinical practice toward rehabilitation of women after stroke.
- Chemical quality of drinking-water in a Northeast Region of PortugalPublication . Afonso, Andrea Luísa Fernandes; Pires, Bruno; Afonso, Eugénia; Teixeira, Cristina; Nogueira, António José M.The chemical and microbiological quality of drinking-water should be considered within overall public health priorities [1]. A poor quality of drinking-water, due to insufficient disinfection or by human contamination, can be a vehicle for transmitting diseases to consumers. Thus, the quality of both raw water (surface water and groundwater) and the drinking-water has a strong impact on the public health. Among the contaminants, nitrates (NO3-) and faecal indicators (such as thermotolerant coliforms, Escherichia coli and enterococci) represents a major concern because these factors have been associated with adverse health outcomes [1,2]. This study analysed contaminants in drinking-water samples (n=361), including surface water and groundwater in the district of Bragança (during the year 2019), according the standardized protocols [3]. We evaluated the relationship of NO3- concentration with microbial drinking-water parameters (heterotrophic plate count-HPC and faecal indicators), as well as, operational parameter used to assess the performance of a water-treatment process (chlorine residuals and pH) [1]. The nitrate concentration (3.38±5.79 mg/L) presented a significant relation with the presence of the fecal contaminant enterococci (p=0.011). There were significant differences (p<0.001) in regards to nitrate concentration between the water samples according to their provenience, such that groundwater presents higher concentration (mean varying from 4.51 to 6.48 mg/mL) than surface water (mean varying from 1.09 to 1.69 mg/mL). The results also showed that, beyond the presence of enterococci, HPC and coliform bacteria was associated with lower levels of residual chlorine (p= 0.008) and pH (p= 0.004), respectively. The results suggests the relevance of chemical evaluation of drinking-water and the linking to the microbiological contamination and the operational control of water-treatment process. Acknowledgements: We acknowledge to Unidade Local de Saúde do Nordeste [1] World Health Organization, in Developing Drinking-Water Quality Regulations and Standards, World Health Organization, Geneva, 2018. [2] Mary, H. Ward M. H.; Jones, R. R.; Brender, J. D.; Kok, T. M.; Weyer, P. J.; Nolan, B. T.; Villanueva, C. M.; Breda, S. G. Drinking Water Nitrate and Human Health: An Updated Review. International Journal of Environmental Research and Public Health 2018, 15, 1557. [3] Standard Methods for the Examination of Water and Wastewater. E.W. Rice, R.B. Baird, A.D. Eaton (23 Eds.), Washington DC, American Public Health Association, 2017.
- Regional variation in incidence and mortality due to hypertension in Sao Tome and PrincipePublication . Costa, J; Anes, Eugénia; Trovoada, M J; Teixeira, CristinaThe analysis of incidence and mortality due to hypertension (HT) provides statistical data for addressing public health programs, particularly in low-income countries where poor health systems impose constraints to address non-communicable diseases (NCDs). This study aims to assess the geographic pattern of incidence and mortality due to HT in Sao Tome and Principe (STP). Methods This is a descriptive ecological study. Aggregated data on new cases of and deaths due to HT by gender, age-group and district (2022-2023) were extracted from the Health National Database (STP Ministry of Health). Age-standardized incidence and mortality rates (ASIR and ASMR) and respective 95% confidence interval (95%CI) were obtained. Mortality-to-incidence ratio (MIR) was computed by district (lower values indicate better quality of care). Comparison between districts was done through standardized incidence ratios (SIR) and respective p-value. Analyses were stratified by gender. Results ASIR and ASMR per 100,000 were, respectively, 1168.9 (95%CI:1103.3-1237.6) and 76.8 (95%CI:62.0-96.2) among men and 2460.6 (95%CI:2365.0-2559.0) and 99.7 (95%CI:81.4-121.6) among women. Incidence of HT was significantly higher than expected (p < 0.001) in Agua Grande, Caue and Lemba with SIR varying from 122.8% (Agua Grande) to 201.1% (Caue) in men and from 125.1% (Lemba) to 224.1% (Caue) in women. Instead, Mé-Zochi presented much lower incidence than expected for both, men (SIR=43.1%;p<0.001) and women (SIR=38.4%;p<0.001). Large differences between districts were observed in MIR, varying from 0% (Caue and Lobata) to 84% (Mé-Zochi) in men and from 0% (Lobata) to 57% (Mé-Zochi) in women. Conclusions According to our findings there is, not only, a high incidence rate of HT, but also regional variation in this rate, deserving particular attention from policy-makers. Regional variation in hypertension incidence could be partially explained by differences in the quality of healthcare services. Key messages • Awareness should be given to the high incidence of hypertension demanding preventive strategies in the field of public health. • Public health strategies should address the quality of care in regards to the prevention, diagnosis and monitoring of hypertension.
- 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.
- Incidência e mortalidade por cancro do estômago em países onde predomina a dieta mediterrânicaPublication . Correia, Beatriz Gonçalves; Mesquita, Cristiana; Fonseca, Fausta; Afonso, Andrea Luísa Fernandes; Nogueira, António José M.; Teixeira, CristinaPaises como Portugal, Espanha, Itália, Grécia, Marrocos Croácia e Chipre, onde se pratica uma dieta do tipo mediterrânico, é expetável um baixo índice de neoplasias gástricas.
- Procura de cuidados de saúde em jovens estudantes: cuidados de saúde primáriosPublication . Silva, Andreia Soraia Afonso Meireles; Anes, Eugénia; Sousa, Filomena; Teixeira, CristinaA fase da adolescência é uma fase de mudança, de novas experiências e de adoção de novos hábitos e comportamentos. Pelo que a procura de cuidados de saúde nesta fase é entendida como um determinante ou um comportamento positivo uma vez que contribui para a prevenção da doença e para a promoção de hábitos e estilos de vida saudáveis. Objetivo: O presente trabalho avaliar a procura de saúde em jovens estudante. Metodologia: Foi utilizado um questionário que avalia a procura dos cuidados de saúde ao qual foram associadas questões de caraterização. Resultados: A amostra é composta por 95 alunos do Curso de Licenciatura em Enfermagem, maioritariamente feminina (79%), com idades compreendidas entre os 17 e os 21 anos. Relativamente à procura de cuidados de saúde, a maior utilização recai sobre o Centro de Saúde (61,9%), a quase totalidade dos estudantes tem médico de família (93,9%) e identificam o seu enfermeiro (60,5%). Os motivos porque procuram os Centros de Saúde estão maioritariamente relacionados com consultas de rotina (46,2), contraceção (15,9) e doença aguda (12,5%). A medicina privada é utilizada por 38% dos estudantes e as medicinas alternativas 29,05%. Concussão: Verificar-se uma subutilização dos Cuidados de Saúde Primários, especialmente na vertente preventiva. Por outro lado, encontramos uma procura significativa da medicina privada e medicinas alternativas. Sendo os cuidados de Saúde primários os principais promotores da promoção da saúde e da prevenção da doença, é impreterível identificar os determinantes da procura destes cuidados.