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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
- 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
- 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.
- Assistência sanitária em contexto Covid 19: que implicações na saúde mental dos enfermeiros?Publication . Pires, Cláudia Sofia Martins; Teixeira, Cristina; Pimentel, Maria HelenaOs enfermeiros no exercício da sua atividade profissional confrontam-se com situações que podem gerar impacto na sua vida. Estes profissionais no exercício da sua atividade profissional não se deparam apenas com o desgaste emocional também com o desgaste físico acrescidos, no caso em análise, à pandemia COVID-19. Alterações ao nível da saúde mental podem implicar, de forma negativa, a qualidade dos cuidados. Avaliar o nível de saúde mental de enfermeiros em atividade em contexto de pandemia COVID-19 e a sua relação com as variáveis de caraterização biossocial e profissional
- 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
- 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.
- 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).