Publications by authors named "Ana Antunes"

116 Publications

The Effects of Training About Prevention of Factors Associated with Musculoskeletal Symptoms on Nursing Students Affectivity.

Florence Nightingale J Nurs 2021 Feb 1;29(1):74-80. Epub 2021 Feb 1.

Department of Human Motricity, Faculty of Medicine, Institute of Environmental Health, University of Lisbon, Lisbon, Portugal.

Aim: This study aimed to evaluate the effectiveness of pedagogical training program for the prevention of musculoskeletal symptoms in affectivity of nursing students.

Method: A quantitative, longitudinal, and quasi-experimental study, which included a pre-test, intervention, and a later test was conducted in a convenience sample of 21 students from the 4 year nursing degree at a private university in the region of Lisboa e Vale do Tejo. A total of 11 students were included in the experimental group and 10 were included in the control group. A multidisciplinary team conducted the musculoskeletal symptoms prevention program to the experimental group. Participants completed the Positive and Negative Affect Schedule Scale before and after attending each of the 6 program sessions that took place between February and April 2019. Each session lasted for about 120 minutes.

Results: Before implementing the program, the groups did not reveal any statistically significant differences in positive and negative affectivities. However, after the program, there were statistically significant differences observed in positive affectivity, showing gains in the experimental group, and a decrease in negative affectivity was observed in the experimental group. A significant increase in positive affectivity was observed in psychotherapeutic techniques.

Conclusion: Is essential the nursing schools provide learning experiences with an impact on students' affectivity to allow a better and more effective integration of knowledge and skills in their training path.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/FNJN.2021.20064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137732PMC
February 2021

A hemlock salad: a case report of super-refractory status epilepticus after accidental hemlock ingestion.

Neurol Sci 2021 Jun 29. Epub 2021 Jun 29.

Department of Critical Care Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10072-021-05421-wDOI Listing
June 2021

Theoretical nursing conceptions in hospitalized child care: scoping review.

Rev Bras Enferm 2021 9;74(3):e20200265. Epub 2021 Jun 9.

Universidade Católica Portuguesa. Instituto de Ciências da Saúde. Lisboa, Portugal.

Objective: Identify the theoretical concepts that have been used in the context of nursing care for hospitalized children.

Methods: Scoping review was carried out according to the PRISMA-ScR methodology. The research limitations included: primary studies dealing with the use of theoretical concepts of nursing in the provision of care to hospitalized children, access in full text, in Portuguese or English and published between 2000 and 2019. Research was carried out on grassroots platforms (EBSCOhost, PubMed, SciELO and Web of Science), gray literature and in the bibliography of selected articles.

Results: 21 studies were found and 10 theoretical conceptions of nursing were identified, with family-centered care being the most used.

Final Considerations: The variability of the identified theoretical conceptions is emphasized, with no evidence to support the use of one in detriment of the other. A more integrative theoretical conception, which adds care centered both on the family and the child, emerges as a research trend.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/0034-7167-2020-0265DOI Listing
June 2021

Factors associated with involuntary psychiatric hospitalization in Portugal.

Int J Ment Health Syst 2021 Apr 20;15(1):37. Epub 2021 Apr 20.

Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.

Background: Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012.

Methods: Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors.

Results: An increment of involuntary hospitalizations was associated with male gender [exp([Formula: see text]) = 1.31; 95%CI 1.06-1.62, p < 0.05], having secondary and higher education [exp([Formula: see text]) = 1.45; 95%CI 1.05-2.01, p < 0.05, and exp([Formula: see text]) = 1.89; 95%CI 1.38-2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp([Formula: see text]) = 2.02; 95%CI 1.59-2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp([Formula: see text]) = 1.61; 95%CI 1.21-2.16, p < 0.01, and exp([Formula: see text]) = 1.73; 95%CI 1.31-2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp([Formula: see text]) = 0.74; 95%CI 0.56-0.99, p < 0.05], having experienced a suicide attempt [exp([Formula: see text]) = 0.26; 95%CI 0.15-0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp([Formula: see text]) = 0.65; 95%CI 0.49-0.86, p < 0.01, exp([Formula: see text]) = 0.67; 95%CI 0.49-0.90, p < 0.01, and exp([Formula: see text]) = 0.67; 95%CI 0.46-0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively].

Conclusions: The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13033-021-00460-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056508PMC
April 2021

Family-Centered practice in a Brazilian rehabilitation network service.

Braz J Phys Ther 2021 Feb 20. Epub 2021 Feb 20.

Departament of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. Electronic address:

Background: Family-centered practice (FCP) is widely accepted as a best practice in pediatric rehabilitation. However, its implementation in Brazil is incipient, and systematic documentation of the extent to which it has been achieved is not available.

Objectives: To determine parents' and service providers' perceptions of family-centeredness and specific areas in need of improvement in four rehabilitation hospitals.

Methods: A total of 107 caregivers and 89 service providers responded to the Measure of Processes of Care-20 (MPOC-20) and the Measure of Processes of Care for Service providers (MPOC-SP), respectively. The MPOC questionnaires evaluate FCP from the point of view of parents and rehabilitation professionals. Domain scores within each questionnaire were compared with Kruskal-Wallis and Mann-Whitney tests. MPOC items with low scores (from 1-4 out of 7 by 33% or more of respondents) were considered to indicate weaknesses in service delivery.

Results: Median MPOC-20 scores varied from 5.2 (4.7, 5.8) (Providing General Information) to 7.0 (6.0, 7.0) (Enabling and Partnership). The Providing General Information scores were significantly lower than those of other domains (p <  0.003). The MPOC-SP scores varied from 4.8 (4.0, 5.8) (Providing General Information) to 6.1 (5.8, 6.6) (Treating People Respectfully). Scores for Treating People Respectfully were significantly higher (p <  0.0001) and Providing General Information scores significantly lower (p <  0.0001) than those of the other domains. Most items with high percentages of low scores were from the domain Providing General Information.

Conclusion: Except for Providing General Information, the results indicated that services implement FCP "to a fairly great extent," comparing favorably to international data. Provision of information can be improved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjpt.2021.02.003DOI Listing
February 2021

Pervasive transmission of E484K and emergence of VUI-NP13L with evidence of SARS-CoV-2 co-infection events by two different lineages in Rio Grande do Sul, Brazil.

Virus Res 2021 04 22;296:198345. Epub 2021 Feb 22.

Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil. Electronic address:

Emergence of novel SARS-CoV-2 lineages are under the spotlight of the media, scientific community and governments. Recent reports of novel variants in the United Kingdom, South Africa and Brazil (B.1.1.28-E484K) have raised intense interest because of a possible higher transmission rate or resistance to the novel vaccines. Nevertheless, the spread of B.1.1.28 (E484K) and other variants in Brazil is still unknown. In this work, we investigated the population structure and genomic complexity of SARS-CoV-2 in Rio Grande do Sul, the southernmost state in Brazil. Most samples sequenced belonged to the B.1.1.28 (E484K) lineage, demonstrating its widespread dispersion. We were the first to identify two independent events of co-infection caused by the occurrence of B.1.1.28 (E484K) with either B.1.1.248 or B.1.91 lineages. Also, clustering analysis revealed the occurrence of a novel cluster of samples circulating in the state (named VUI-NP13L) characterized by 12 lineage-defining mutations. In light of the evidence for E484K dispersion, co-infection and emergence of VUI-NP13 L in Rio Grande do Sul, we reaffirm the importance of establishing strict and effective social distancing measures to counter the spread of potentially more hazardous SARS-CoV-2 strains.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.virusres.2021.198345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898980PMC
April 2021

Singular case of acanthosis nigricans.

BMJ Case Rep 2021 Feb 10;14(2). Epub 2021 Feb 10.

Paediatric, Hospital de Braga, Braga, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-240143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878120PMC
February 2021

The impact of COVID-19 on rare and complex connective tissue diseases: the experience of ERN ReCONNET.

Nat Rev Rheumatol 2021 03 6;17(3):177-184. Epub 2021 Jan 6.

Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.

During the COVID-19 pandemic, the need to provide high-level care for a large number of patients with COVID-19 has affected resourcing for, and limited the routine care of, all other conditions. The impact of this health emergency is particularly relevant in the rare connective tissue diseases (rCTDs) communities, as discussed in this Perspective article by the multi-stakeholder European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET). The clinical, organizational and health economic challenges faced by health-care providers, institutions, patients and their families during the SARS-CoV-2 outbreak have demonstrated the importance of ensuring continuity of care in the management of rCTDs, including adequate diagnostics and monitoring protocols, and highlighted the need for a structured emergency strategy. The vulnerability of patients with rCTDs needs to be taken into account when planning future health policies, in preparation for not only the post-COVID era, but also any possible new health emergencies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41584-020-00565-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786339PMC
March 2021

Follow-up of infants born to mothers with Graves' disease.

Endocrinol Diabetes Nutr 2021 Aug-Sep;68(7):472-480. Epub 2020 Dec 30.

Pediatric Endrocrinology Unit of Pediatric Department, Hospital de Braga, Braga, Portugal.

Introduction: The prevalence of neonatal hyperthyroidism (HN) due to maternal Graves Disease (GD) ranges from 0.1 to 2.7%. It may occur in pregnant women with the following: active DG, after treatment with radioactive iodine, anti-thyroid or thyroidectomy or with a previous child with hyperthyroidism. The aim of our observational study was to evaluate the follow-up of infants born to mothers with GD at a Tertiary Hospital prior to the implementation of a follow-up protocol.

Methods: This was a retrospective observational study using data from the medical records of mothers with a diagnosis of GD and their newborns from January 2013 until May 2018. Newborns were divided into two groups: high and low risk for NH according to maternal TRAb, third trimester treatment and signs of fetal hyperthyroidism.

Results: We identified 31 newborns, 58% female; 87% high risk. In none of the newborns was umbilical cord blood collected. In the high risk group, 22% had thyroid function evaluation at day-1, one patient presented with hyperthyroidism and 82% were asymptomatic. Considering the cases with an insufficient blood sample for analysis, 9 consultations would have been spared. We found a significant delay in obtaining the high-risk group results which would have spared 10 appointments. A positive correlation was found between age at outpatient clinic discharge and the number of appointments and the maternal TRAb titer.

Conclusion: The correct surveillance of pregnancy and newborns with identification of those at high risk is essential to avoid unnecessary consultations and blood analyses that increase parental anxiety and hospital costs. Consequently, a multidisciplinary protocol was created to standardize the approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.endinu.2020.09.005DOI Listing
December 2020

Cutaneous Manifestations in Four Patients with COVID-19.

Eur J Case Rep Intern Med 2020 5;7(12):002029. Epub 2020 Nov 5.

Hospital de Cascais, Cascais, Portugal.

As the numbers of SARS-CoV-2 infections increased globally, reports of cutaneous manifestations started to emerge. We describe several patients with COVID-19 who presented with skin changes. We noted such manifestations in four out of 110 patients (3.63%) and describe the clinical situation of each of these patients. Each patient had either a maculopapular or a urticariform rash. These manifestations have a broad differential diagnosis and it was difficult to exclude drug reactions. We hope to raise awareness of this possible manifestation of COVID-19 in order to raise suspicion of this diagnosis among clinicians when they encounter patients with fever and rash. Larger series that also include patients with mild disease and skin biopsies may be useful.

Learning Points: Cutaneous manifestations can occur as part of COVID-19, so clinicians should be suspicious of this diagnosis in patients with fever and rash.The differential diagnosis is large and drug reactions are difficult to rule out.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12890/2020_002029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727628PMC
November 2020

The experience of school-aged children with hospitalisation.

J Clin Nurs 2021 Feb 5;30(3-4):550-558. Epub 2020 Dec 5.

Universidade Católica Portuguesa, Lisboa, Portugal.

Aims And Objectives: This study intended to contribute to the improvement of nursing care for both children and their parents and aimed to identify the best and worst experiences of school-aged children during hospitalisation.

Background: Child hospitalisation has traditionally been studied from the parent's perspective, but studies in which the child is the subject are scarce and mainly focus on to the hospitalisation experiences.

Design: A cross-sectional, observational and descriptive exploratory design was used, and STROBE reporting guidelines were followed.

Methods: A paper survey was applied by the primary researcher within a 3 months period to 252 children. It presented two open-ended statements: 'In my opinion the best thing about the hospital is …' and 'In my opinion the worst thing about the hospital is…'. The study was submitted and approved by the national data protection commission and also by the ethics committees of each of the six institutions where the study was undertaken. Informed consent was also obtained from children and parents.

Results: Answers were analysed through content analysis. Five categories were identified for each of the open-ended statements. Children identified 'people', 'physical environment', 'activities', 'outcomes' and 'food' as best experiences. The worst experiences included: 'feelings', 'activities', 'food', 'environment' and 'outcomes'.

Conclusions: The results allowed the identification of the children's most valued aspects of hospitalisation.

Relevance To Clinical Practice: The results should be considered by healthcare professionals in order to make the hospitalisation experience more positive from the perspective of the school-aged children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocn.15574DOI Listing
February 2021

Transient Multivalent Nanobody Targeting to CD206-Expressing Cells via PH-Degradable Nanogels.

Cells 2020 10 1;9(10). Epub 2020 Oct 1.

Max Planck Institute for Polymer Research, Ackermannweg 10, 55128 Mainz, Germany.

To target nanomedicines to specific cells, especially of the immune system, nanobodies can be considered as an attractive tool, as they lack the Fc part as compared to traditional antibodies and, thus, prevent unfavorable Fc-receptor mediated mistargeting. For that purpose, we have site-specifically conjugated CD206/MMR-targeting nanobodies to three types of dye-labeled nanogel derivatives: non-degradable nanogels, acid-degradable nanogels (with ketal crosslinks), and single polymer chains (also obtained after nanogel degradation). All of them can be obtained from the same reactive ester precursor block copolymer. After incubation with naïve or MMR-expressing Chinese hamster ovary (CHO) cells, a nanobody mediated targeting and uptake could be confirmed for the nanobody-modified nanocarriers. Thereby, the intact nanogels that display nanobodies on their surface in a multivalent way showed a much stronger binding and uptake compared to the soluble polymers. Based on their acidic pH-responsive degradation potential, ketal crosslinked nanogels are capable of mediating a transient targeting that gets diminished upon unfolding into single polymer chains after endosomal acidification. Such control over particle integrity and targeting performance can be considered as highly attractive for safe and controllable immunodrug delivery purposes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cells9102222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600184PMC
October 2020

Accelerated Weathering Effects on Poly(3-hydroxybutyrate--3-hydroxyvalerate) (PHBV) and PHBV/TiO Nanocomposites.

Polymers (Basel) 2020 Aug 5;12(8). Epub 2020 Aug 5.

Center for Advanced Materials, Qatar University, P.O. Box 2713 Doha, Qatar.

The effect of accelerated weathering on poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and PHBV-based nanocomposites with rutile titanium (IV) dioxide (PHBV/TiO) was investigated. The accelerated weathering test applied consecutive steps of UV irradiation (at 340 nm and 0.76 W m irradiance) and moisture at 50 °C following the ASTM D4329 standard for up to 2000 h of exposure time. The morphology, chemical structure, crystallization, as well as the mechanical and thermal properties were studied. Samples were characterized after 500, 1000, and 2000 h of exposure time. Different degradation mechanisms were proposed to occur during the weathering exposure and were confirmed based on the experimental data. The PHBV surface revealed cracks and increasing roughness with the increasing exposure time, whereas the PHBV/TiO nanocomposites showed surface changes only after 2000 h of accelerated weathering. The degradation of neat PHBV under moisture and UV exposure occurred preferentially in the amorphous phase. In contrast, the presence of TiO in the nanocomposites retarded this process, but the degradation would occur simultaneously in both the amorphous and crystalline segments of the polymer after long exposure times. The thermal stability, as well as the temperature and rate of crystallization, decreased in the absence of TiO. TiO not only provided UV protection, but also restricted the physical mobility of the polymer chains, acting as a nucleating agent during the crystallization process. It also slowed down the decrease in mechanical properties. The mechanical properties were shown to gradually decrease for the PHBV/TiO nanocomposites, whereas a sharp drop was observed for the neat PHBV after an accelerated weathering exposure. Atomic force microscopy (AFM), using the amplitude modulation-frequency modulation (AM-FM) tool, also confirmed the mechanical changes in the surface area of the PHBV and PHBV/TiO samples after accelerated weathering exposure. The changes in the physical and chemical properties of PHBV/TiO confirm the barrier activity of TiO for weathering attack and its retardation of the degradation process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/polym12081743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464598PMC
August 2020

Total Protein as Investigated by Cerebral Microdialysis Increases in Hypothermic Cardiac Arrest: A Pig Study.

Ther Hypothermia Temp Manag 2021 Mar 4;11(1):28-34. Epub 2020 Aug 4.

Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria.

The understanding and neurological prognostication of hypoxic ischemic encephalopathy (HIE) after hypothermic cardiac arrest (CA) is limited. Recent data suggest that the protein total might be a useful marker for outcome in patients with HIE. This translational porcine study aimed to analyze brain physiology in relation to total protein release during hypothermic CA. Eight domestic pigs were studied as part of a prospective porcine study using cerebral microdialysis (CMD). CMD samples for analysis were collected at baseline, after reaching the targeted core temperature of 28°C (hypothermia), after hypoxic hypercapnia (partial asphyxia), and finally 20 minutes after cardiopulmonary resuscitation. CMD-total -protein was analyzed using enzyme-linked immunosorbent essay. Cerebral protein was slightly elevated at baseline most likely due to an insertion trauma, remained stable during hypercapnic hypoxia, and significantly ( = 0.009) increased in 8/8 pigs during resuscitation to 1335 pg/mL (interquartile range: 705-2100). CMD- release was associated with lower levels of brain tissue oxygen tension ( = 0.011), higher CMD-lactate/pyruvate ratio, higher CMD-lactate, CMD-glutamate, and CMD-glycerol levels ( < 0.001, respectively), but not with cerebral perfusion pressure, intracranial pressure, or CMD-glucose levels. This study demonstrates an immediate protein release accompanied by deranged cerebral metabolism and decreased brain tissue oxygen tension during mechanical resuscitation in hypothermic CA. Understanding physiology and release kinetics is important for the design and interpretation of studies investigating as a biomarker of HIE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/ther.2020.0016DOI Listing
March 2021

Nonsyndromic hereditary gingival fibromatosis: Characterization of a family and review of genetic etiology.

Spec Care Dentist 2020 May 15;40(3):320-328. Epub 2020 May 15.

Faculty of Medicine, Institute of Medical Genetics, University of Coimbra, Coimbra, Portugal.

Our aim is to describe a family with a nonsyndromic form of hereditary gingival fibromatosis (HGF) and discuss genetic characteristics of this rare disease by reviewing reported cases. A mother and three descendants were diagnosed with HGF. There was marked variable expressivity: from severe generalized gingival overgrowth in a 16-year-old boy (the proband) to minimal manifestations in the mother. The proband was submitted to gingivectomy and gingivoplasty. In younger siblings, the disease remained stable for 5 years, suggesting that clinical surveillance is a good option. The diagnosis was supported by histopathological examination. Analysis of this family and literature-reported cases supports that HGF most frequently shows an autosomal dominant inheritance with high penetrance and variable expressivity. Neomutations and gonadal mosaicism do not seem to be a rare event. Although five loci have been mapped by linkage analysis, only two genes, SOS1 and REST, were identified in four families.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/scd.12458DOI Listing
May 2020

Effects of Rutile-TiO Nanoparticles on Accelerated Weathering Degradation of Poly(Lactic Acid).

Polymers (Basel) 2020 May 11;12(5). Epub 2020 May 11.

Center for Advanced Materials, Qatar University, Doha PO Box 2713, Qatar.

The effect of accelerated weathering on poly(lactic acid) (PLA) and a PLA nanocomposite with rutile titanium (IV) dioxide (rutile-TiO) was investigated. The accelerated weathering test applied consecutive steps of ultraviolet (UV) (at 340 nm and 0.76 W m irradiance) and moisture at 50 °C for 2000 h, following the ASTM D4329 standard. The morphology, chemical structure, molecular weight, crystallization, as well as mechanical and thermal properties were thoroughly studied. Samples were characterized after 500 h, 1000 h and 2000 h exposure. Different degradation mechanisms were proposed to happen during the weathering exposure and confirmed based on the experimental data. The PLA and PLA/TiO surfaces presented holes and increasing roughness over the exposure time. The molecular weight of the weathered samples decreased due to chain scission during the degradation processes. Thermal stability decreased in the presence of TiO and a double melting peak was observed for the PLA/TiO nanocomposite. A general improvement in the mechanical properties of the PLA/TiO nanocomposite was observed over time during the accelerated weathering analysis up to 1000 h of exposure time. After 2000 h of weathering exposure, the PLA and PLA/TiO became extremely brittle and lost their ductile properties. This was ascribed to a significant increase in the degree of crystallinity upon weathering, which was accelerated in the presence of TiO. Atomic force microscopy (AFM) using amplitude modulation-frequency modulation (AM-FM) tool confirmed the mechanical changes in the surface area of the PLA samples after accelerated weathering exposure. The stiffness and Young's modulus achieved higher values than the unweathered ones up to 1000 h of exposure time. The changes in the physical and chemical properties of PLA/TiO over the ageing time confirm the photocatalytic activity of rutile-TiO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/polym12051096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285358PMC
May 2020

How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey.

BMC Psychiatry 2020 05 11;20(1):215. Epub 2020 May 11.

Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal.

Background: Research suggests that economic recessions might be associated with a higher use of psychotropic drugs, but literature is scarce and contradictory in identifying the most vulnerable groups. This study aims to assess possible changes in the use of psychotropic drugs due to the economic recession in Portugal, by comparing self-reported consumption in 2008/09 and 2015/16.

Methods: Data from the World Mental Health Survey Initiative Portugal (2008/09) and the National Mental Health Survey Follow-Up (2015/16) were used (n = 911). McNemar's tests were performed to estimate changes in consumption of any psychotropic drug and of antidepressants, anxiolytics, and hypnotics/sedatives. Multiple Generalised Estimating Equations models with interaction effects were used to estimate the population odds of consuming psychotropic drugs according to year, gender and age.

Results: An increase of 6.74% was estimated in the consumption of psychotropic drugs from 2008/09 to 2015/16. Population odds of consuming any psychotropic drugs in 2015/16 were estimated to be 1.5 times higher than in 2008/09 (OR = 1.50;95%CI:1.13-2.01), particularly for hypnotics/sedatives (OR = 1.60;95%CI:1.14-2.25). Women and older individuals presented higher odds of consuming any psychotropic drugs (OR = 2.79;95%CI:2.03-3.84, and OR = 1.80;95%CI:1.28-2.54), after adjusting for year of assessment and education. However, when evaluating the interaction effect of the year with gender and age, men and younger individuals reported higher odds of consuming any psychotropic drugs in 2015/16, when compared to 2008/09 (OR = 1.85;95%CI:1.08-3.17, and OR = 1.95;95%CI:1.32-2.90, respectively).

Conclusions: The findings indicate that the period of economic recession was associated with an increased risk of psychotropic drugs use in Portugal. Consumption of psychotropic drugs remained higher among women and older individuals, but the results suggest that the economic crisis had a disproportionate impact on men and younger individuals. This identification of the most vulnerable population groups is useful to design effective and targeted public health interventions aimed at alleviating the effects of economic recessions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12888-020-02620-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216710PMC
May 2020

Lymphopenia as a risk factor for neurologic involvement and organ damage accrual in patients with systemic lupus erythematosus: A multi-center observational study.

Semin Arthritis Rheum 2020 12 4;50(6):1387-1393. Epub 2020 Mar 4.

Department of Medical Sciences, Division of Rheumatology, Uppsala University, Uppsala 751 85, Sweden.

Objective: Detailed analysis of hematological manifestations (HM) in systemic lupus erythematosus (SLE) are limited and their clinical impact on disease remain obscure. Here, we aimed to decipher factors associated with different hematological abnormalities in SLE patients and to assess their impact on disease related outcomes.

Methods: A dataset (GIPT) originating from SLE patients of six European tertiary centers was assessed. Six-monthly visits of each patient for at least 2 years were registered. The association between hematologic manifestations (HM; per ACR-1997criteria) and clinical/serologic variables, as well as the impact of HM on disease related outcomes (damage, infection and hemorrhage) were explored. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI2K), the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) and events for any infection and hemorrhage were recorded. Results were compared with a cross-sectional, well-characterized SLE dataset from Sweden. Descriptive statistics, the generalized estimating equations (GEE), general linear models (GLM), Cox regression models were applied.

Results: We monitored 1425 longitudinal visits in 286 SLE patients with HM (GIPT dataset: 88% female, 95% Caucasian, 68% dsDNA positive). Thrombocytopenia (regression coefficient [95% confidence interval] 1.86[1.1-3.13]) and neurologic involvement (ACR-8) (2.1[1.10-3.89]) were associated with lymphopenia (<1000/mm); the latter was an independent predictor of organ damage accrual (1.68[1.2-2.62]). These associations were confirmed in an independent dataset of 1348 SLE patients (86% female, 93% Caucasian, 61% dsDNA positive) in Sweden.Severe lymphopenia (<500/mm) and severe thrombocytopenia (<20 K/mm) were associated with increased risk for infection (hazard ratio [95% confidence interval] 2.56[1.23-5.31]) and hemorrhage (4.38[2.10-11.1]), respectively, independent of the effect of other predictors.

Conclusion: Lymphopenia in SLE is independently associated with neurologic involvement and organ damage accrual, and thus, may be considered as a marker of severe/progressive disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.semarthrit.2020.02.020DOI Listing
December 2020

Barriers to mental health services utilisation in Portugal - results from the National Mental Health Survey.

J Ment Health 2020 Mar 23:1-9. Epub 2020 Mar 23.

Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal.

The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap. To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal. Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal). The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72-6.46), and disability (OR = 2.43; 95% CI: 1.33-4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20-0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24-0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42-5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01-2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10-0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01-3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28-0.90) and mood disorders (OR = 0.16; 95% CI: 0.09-0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29-10.92). This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638237.2020.1739249DOI Listing
March 2020

Dyspnea in antiphospholipid syndrome: Beyond pulmonary embolism.

Rev Port Cardiol (Engl Ed) 2020 Jan 12;39(1):47.e1-47.e5. Epub 2020 Mar 12.

Unidade de Hipertensão Pulmonar, Serviço de Cardiologia - Hospital Garcia de Orta (HGO), Almada, Portugal.

Pulmonary embolism due to primary antiphospholipid syndrome is rarely associated with chronic thromboembolic pulmonary hypertension, and therefore according to the latest guidelines on pulmonary hypertension, routine screening is not recommended. We describe a young patient with a late diagnosis of chronic thromboembolic pulmonary hypertension in the context of pulmonary embolism, primary antiphospholipid syndrome and suboptimal anticoagulation. Of note, mild cardiopulmonary symptoms were consistently misattributed to a depressive disorder because physical examination was normal, serial Doppler echocardiography failed to show pulmonary hypertension, and all other diagnostic tests were normal. Once symptoms became severe, positive screening tests led to the correct diagnosis and surgical referral, and bilateral pulmonary endarterectomy was successfully performed. This case demonstrates the need for extra awareness in patients with antiphospholipid syndrome and pulmonary embolism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.repc.2018.01.015DOI Listing
January 2020

Identifying the variables that drive tamoxifen-independent CreERT2 recombination: Implications for microglial fate mapping and gene deletions.

Eur J Immunol 2020 03 11;50(3):459-463. Epub 2019 Dec 11.

Myeloid Cell Immunology Lab, VIB Center for Inflammation Research, Brussels, Belgium.

Ligand-dependent Cre recombinases such as the CreERT2 system allow for tamoxifen-inducible Cre recombination. Important examples are the Cx3cr1-CreERT2 and Sall1-CreERT2 lines that are widely used for fate mapping and gene deletion studies of brain macrophages. Our results now show that both CreERT2 lines can exhibit a high rate of tamoxifen-independent "leaky" excision with some reporter strains, while this is not observed with others. We suggest that this disparity is determined by the length of the floxed transcriptional STOP cassette that is incorporated in the various reporter lines. In addition, the rate of spontaneous recombination was also determined by the CreERT2 expression levels and the longevity of the CreERT2-expressing cells. The implications of these results are discussed in the context of fate mapping and inducible gene deletion studies in macrophages and microglia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eji.201948162DOI Listing
March 2020

Trauma exposure and ptsd in portugal: Findings from the world mental health survey initiative.

Psychiatry Res 2020 02 25;284:112644. Epub 2019 Oct 25.

Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal.

Although trauma is common worldwide, the relative importance of different types of events in the development of PTSD varies across countries. This study evaluated the exposure to traumatic events, the conditional risk of PTSD, and the sociodemographic factors associated with traumatic events, lifetime and 12-month prevalence of PTSD in Portugal. Data from the World Mental Health Survey Initiative Portugal were used. The worst traumatic event reported by each participant was used to generate estimates of PTSD associated with each event. Conditional risk of PTSD was evaluated in relation to each class and type of traumatic event. Logistic regression models evaluated the association between sociodemographic factors and exposure to traumatic events, lifetime and 12-month PTSD. Most participants were exposed to traumatic events. Sexual violence presented the highest conditional risk of PTSD. Women were less likely to report any lifetime traumatic event. However, after adjusting for type of trauma, women were 2.7 times more likely to experience lifetime PTSD than men. This study may contribute to the design of interventions aiming to reduce the societal burden of PTSD in Portugal, drawing attention to the need to recognize sexual violence and gender inequalities as public health priorities in the country.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2019.112644DOI Listing
February 2020

Long-term Neuropsychiatric and Neuropsychological Sequelae of Endovascularly Treated Aneurysmal Subarachnoid Hemorrhage.

Acta Med Port 2019 Nov 4;32(11):706-713. Epub 2019 Nov 4.

Department of Neuroradiology. Santa Maria University Hospital. Lisbon. Portugal.

Introduction: There is limited evidence regarding long-term outcomes of aneurysmal subarachnoid hemorrhage survivors. Most follow-up programs are relatively short and focused on physical functions. Endovascular aneurysmal embolization enables recovery of normal vascular architecture. However, there is growing evidence that neuropsychological and behavior sequelae can significantly impact the lives of these patients, even when treatment is successful. In this study, we reviewed cognition, psychiatric and neuropsychological symptoms, global functionality, and health-related quality of life 10 to 12 years after an aneurysmal subarachnoid hemorrhage.

Material And Methods: A cross-sectional observational study was carried out in a university hospital. All cases of aneurysmal subarachnoid hemorrhage admitted between January 2004 and December 2006 and endovascularly treated were reviewed. Participants underwent a neuropsychological evaluation and a clinical interview with a psychiatrist.

Results: Fourteen patients participated in the study. Almost 70% (n = 10) showed cognitive impairment; in more than 40% (n = 6) of the subjects, significant symptoms of anxiety were identified, and 35% (n = 5) were classified as having clinical depression. Relevant posttraumatic symptoms were reported by more than 70% (n = 10) of patients, and almost 30% (n = 4) showed other moderate neuropsychiatric symptoms. Overall, health-related quality of life was impaired, and personality changes were frequently reported by the participants and their relatives.

Discussion: A significant prevalence of ongoing deficits in high-level functioning and reduced health-related quality of life were observed in a sample of young and professionally active individuals that were successfully treated and discharged from follow-up consultations.

Conclusion: There is a need for better follow-up strategies, targeting more subtle deficits and psychological symptoms after aneurysmal subarachnoid hemorrhage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20344/amp.10894DOI Listing
November 2019

Solutions to tackle the mental health consequences of the economic recession: A qualitative study integrating primary health care users and professionals' perspectives.

Health Policy 2019 12 17;123(12):1267-1274. Epub 2019 Oct 17.

Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Portugal; Lisbon Institute of Global Mental Health, Portugal.

This qualitative study explores solutions proposed by primary health care users and professionals to address the consequences of the economic recession and austerity measures on populations' mental health and delivery of care in Portugal. Qualitative data were collected in three primary health care centres in the Lisbon Metropolitan Area. Five focus groups with 26 users and semistructured interviews with 27 health professionals were conducted. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Solutions proposed by users focused on improvements in accessibility and management of services, socioeconomic and living conditions, human resources for health, and investment in mental health. Health professionals focused on improvements in integration and articulation of services, infrastructure and structural barriers to primary care, recruitment and retention of human resources, and socioeconomic and living conditions. The themes from both groups were integrated and organized into three axes for action: 1) increasing investment and reversing austerity measures in health and social sectors; 2) coordination and integration of mental health care; and 3) tackling the social determinants of mental health. The findings provide an assessment of the needs and priorities set by primary health care users and professionals, reflecting their contextspecific experiences. These complementary perspectives highlight the need for inter-sectoral efforts in policy-making to improve delivery of care and to mitigate social inequalities in health across the Portuguese population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2019.10.003DOI Listing
December 2019

Humor intervention in the nurse-patient interaction.

Rev Bras Enferm 2019 Aug 19;72(4):1078-1085. Epub 2019 Aug 19.

Escola Superior de Saúde Atlântica. Barcarena, Portugal.

Objective: To describe the factors influencing the use of humor in nursing care, its applicability and benefits.

Method: A scoping review was performed using the Arksey and O'Mally methodology. A search for articles published between 2008 and 2018 was performed using the platforms EBSCO Host, Virtual Health Library and Google Scholar.

Results: From the initial 465 articles found, 17 were included for final revision. Data allowed to retrieve information on humor definition; its applicability as a nursing intervention; humor as a tool to improve nurse-patient communication and relationship; influence factors; type of humor interventions; humor benefits in health care context and; limitations and precautions of humor intervention.

Conclusion: The use of humor promotes both communication and human interaction; it promotes well-being; helps deal/cope with difficult and unpleasant situations, reduces tension, discomfort and stress; and strengthens the immune system. This intervention should be used with caution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/0034-7167-2018-0609DOI Listing
August 2019

Untargeted metabolomics of strawberry (Fragaria x ananassa 'Camarosa') fruit from plants grown under osmotic stress conditions.

J Sci Food Agric 2019 Dec 17;99(15):6973-6980. Epub 2019 Sep 17.

Graduate Program in Food Science and Technology, Department of Agroindustrial Science and Technology, School of Agronomy 'Eliseu Maciel', Federal University of Pelotas, Pelotas, Brazil.

Background: Plants activate defense mechanisms to cope with adverse environmental conditions, leading to the accumulation and / or depletion of general and specialized metabolites. In this study, a multiplatform untargeted metabolomics strategy was employed to evaluate metabolic changes in strawberry fruit of cv. Camarosa grown under osmotic stress conditions. Liquid chromatography-mass spectrometry (LC-MS/MS) and gas chromatography-mass spectrometry (GC-MS) data from strawberries grown under two water-deficit conditions, irrigated at 95% crop evapotranspiration (ETc) and 85% ETc, and one excess salt condition with a 80 mmol L NaCl solution, were analyzed to determine treatment effects on fruit metabolism.

Results: Multivariate principal component analysis, orthogonal projections to latent structures - discriminant analysis (OPLS-DA), and univariate statistical analyses were applied to the data set. While multivariate analyses showed group separation by treatment, T-tests and fold change revealed 12 metabolites differentially accumulated in strawberries from different treatments - among them phenolic compounds, glycerophospholipids, phytosterols, carbohydrates, and an aromatic amino acid.

Conclusion: Untargeted metabolomic analysis allowed for the annotation of compounds differentially accumulated in strawberry fruit from plants grown under osmotic stress and non-stressed plants. The metabolic disturbance in plants under stress involved metabolites associated with the inhibition of reactive oxygen species and cell-wall and membrane lipid biosynthesis, which might serve as osmotic stress biomarkers. © 2019 Society of Chemical Industry.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jsfa.9986DOI Listing
December 2019

Septic arthritis incidence and risk factors: a 5-year cross-sectional study.

Infect Dis (Lond) 2019 08 26;51(8):635-637. Epub 2019 Jun 26.

a Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC) , Lisboa , Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/23744235.2019.1633471DOI Listing
August 2019

Primary care physicians' decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research.

BMJ Open 2019 04 3;9(4):e023832. Epub 2019 Apr 3.

Family Medicine Unit, Nova Medical School, Nova University of Lisbon, Lisboa, Portugal.

Introduction: Good patient outcomes correlate with the physicians' capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians' perspectives, views or experiences on decision-making with patients with multimorbidity.

Methods And Analysis: This will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians' perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.

Ethics And Dissemination: This review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).

Prospero Registration Number: ID 91978.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2018-023832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500233PMC
April 2019

Musculoskeletal symptoms in nursing students: concept analysis.

Rev Bras Enferm 2019 Jan-Feb;72(1):287-292

Faculdade Motricidade Humana, Departamento Educação em Saúde. Dafundo, Portugal.

Objective: to analyze the musculoskeletal symptomatology concept in undergraduate nursing students through Rodgers' evolutionary method.

Method: An integrative review of the literature was performed for the identification and selection of ten articles. A concept analysis was performed according to Rodgers' evolutionary method. Article search was performed using the EBOSCO Host platform, Virtual Health Library and Google scholar for the years from 2004 to 2018.

Results: Based on the 3 elements of Rodgers model we found: 1) substitute terms and related concepts, where musculoskeletal disorders and musculoskeletal symptoms were highlighted; 2) as essential attributes of the concept we highlight pain and discomfort, as well as, measurement using the Nordic Musculoskeletal Questionnaire; and 3) risk factors were identified as antecedents, and the consequences were the impact on students' lives.

Conclusions: This study contributes to the knowledge and clarification of the concept of musculoskeletal symptomatology in nursing students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/0034-7167-2018-0612DOI Listing
May 2019

CYP21A2 Gene Pathogenic Variants: A Multicenter Study on Genotype-Phenotype Correlation from a Portuguese Pediatric Cohort.

Horm Res Paediatr 2019 19;91(1):33-45. Epub 2019 Mar 19.

Department of Pediatric Endocrinology, Centro Materno-infantil do Norte, Porto, Portugal.

Background: Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is an autosomal recessive disorder characterized by 3 overlapping phenotypes: salt-wasting (SW), simple virilizing (SV), and non-classic (NC). We aimed at conducting a nationwide genotype description of the CAH pediatric patients and to establish their genotype-phenotype correlation.

Methods: CAH patients were recruited from Portuguese pediatric endocrinology centers and classified as SW, SV, or NC. Genetic analysis was performed by polymerase chain reaction (sequence specific primer, restriction fragment length polymorphism) or direct Sanger sequencing. Genotypes were categorized into 4 groups (0, A, B, and C), according to their predicted enzymatic activity. In each group, the expected phenotype was compared to the observed phenotype to assess the genotype-phenotype correlation.

Results: Our cohort comprises 212 unrelated pediatric CAH patients (29% SW, 11% SV, 60% NC). The most common pathogenic variant was p.(Val282Leu; 41.3% of the 424 alleles analyzed). The p.(Val282Leu) variant, together with c.293-13A/C>G, p.(Ile173Asn), p.(Leu308Thr), p.(Gln319*), and large deletions/conversions were responsible for 86.4% of the mutated alleles. Patients' stratification by disease subtype revealed that the most frequent pathogenic variants were c.293-13A/C>G in SW (31.1%), p.(Ile173Asn) in SV (46.9%), and p.(Val282Leu) in NC (69.5%). The most common genotype was homozygosity for p.(Val282Leu; 33.0%). Moreover, we found 2 novel variants: p.(Ile161Thr) and p.(Trp202Arg), in exons 4 and 5, respectively. The global genotype-phenotype correlation was 92.4%. Group B (associated with the SV form) showed the lowest genotype-phenotype correlation (80%).

Conclusion: Our cohort has one of the largest NC CAH pediatric populations described. We emphasize the high frequency of the p.(Val282Leu) variant and the very high genotype-phenotype correlation observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000497485DOI Listing
November 2019