Publications by authors named "Raquel Fonseca"

15 Publications

  • Page 1 of 1

Accounting for the Rise of Health Spending and Longevity.

J Eur Econ Assoc 2021 Feb 12;19(1):536-579. Epub 2020 Mar 12.

University of Southern California.

We estimate a stochastic life-cycle model of endogenous health spending, asset accumulation and retirement to investigate the causes behind the increase in health spending and longevity in the U.S. over the period 1965-2005. Accounting for changes over time in taxes, transfers, Social Security, income, health insurance, smoking and obesity, and technological progress, we estimate that technological progress is responsible for half of the increase in life expectancy over the period. Substantial growth in health spending over the period is largely the result of growth in economic resources and the generosity of health insurance, with a modest role for medical technological progress. The growth in spending does not come from changes in a single source, but sources jointly interacted to increase spending: complementarity effects explain up to 26.3% of the increase in health spending. Overall, for those born in 1940, the combined changes in resources and health insurance that occurred over the period are valued at 35.7% of lifetime consumption.
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http://dx.doi.org/10.1093/jeea/jvaa003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935060PMC
February 2021

Maintenance of Autonomy Through exerCise in Hospital Setting (MATCH): A Feasibility Study.

J Am Med Dir Assoc 2021 Apr 8;22(4):873-875. Epub 2021 Feb 8.

Centre de recherche, Institut universitaire de gériatrie de Montréal (IUGM), Département des sciences de l'activité physique, Université du Québec à; Montréal, Montreal, Canada.

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http://dx.doi.org/10.1016/j.jamda.2020.12.043DOI Listing
April 2021

Postoperative Epidural Analgesia in Cesarean Section: Comparison of Therapeutic Schemes.

Cureus 2020 Dec 19;12(12):e12166. Epub 2020 Dec 19.

Anesthesiology, Leiria Hospital Center, Leiria, PRT.

Background Cesarean section is associated with moderate to severe postoperative pain. Its adequate control is fundamental to postpartum functional recovery, prevention of chronic pain, and postpartum depression. In this context, neuraxial analgesia has shown superior results. However, the best pharmacological regimen is still unknown. This study intended to compare the performance of three epidural therapeutic schemes (0.1% ropivacaine combined with epidural morphine vs 0.2% ropivacaine combined with epidural morphine vs morphine bolus) in pain intensity and its adverse effects in the early postoperative period of cesarean section. Methods A retrospective observational study was carried out. The sample included 204 women who underwent cesarean section after previous epidural catheter placement. Demographic and clinical data were collected. Pain intensity in rest, movement at 24 and 48 hours, and adverse effects (pruritus, nausea, sedation, respiratory depression, hypotension, urinary retention and paresthesias) were recorded.  Results Statistical analysis revealed no differences in mean pain scores between groups on the first and second postoperative days. The incidence of adverse effects was significantly lower in the morphine bolus group. Conclusion Epidural morphine therapy is an effective option with an adequate safety profile. The addition of a local anesthetic seems to offer no benefit in this context, increasing the incidence of adverse effects.
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http://dx.doi.org/10.7759/cureus.12166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813929PMC
December 2020

Comparing the education gradient in health deterioration among the elderly in six OECD countries.

Health Policy 2020 03 17;124(3):326-335. Epub 2020 Jan 17.

CIRANO, 130 Sherbrooke Street West #1400, Montreal, QC, H3A 2M8, Canada; McGill University, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada; CIREQ, 3150, Jean-Brillant Street, Montreal, QC, H3T 1N8, Canada. Electronic address:

Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems.
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http://dx.doi.org/10.1016/j.healthpol.2019.12.015DOI Listing
March 2020

The KDM5A/RBP2 histone demethylase represses NOTCH signaling to sustain neuroendocrine differentiation and promote small cell lung cancer tumorigenesis.

Genes Dev 2019 12 14;33(23-24):1718-1738. Epub 2019 Nov 14.

Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.

More than 90% of small cell lung cancers (SCLCs) harbor loss-of-function mutations in the tumor suppressor gene The canonical function of the gene product, pRB, is to repress the E2F transcription factor family, but pRB also functions to regulate cellular differentiation in part through its binding to the histone demethylase KDM5A (also known as RBP2 or JARID1A). We show that KDM5A promotes SCLC proliferation and SCLC's neuroendocrine differentiation phenotype in part by sustaining expression of the neuroendocrine transcription factor ASCL1. Mechanistically, we found that KDM5A sustains ASCL1 levels and neuroendocrine differentiation by repressing NOTCH2 and NOTCH target genes. To test the role of KDM5A in SCLC tumorigenesis in vivo, we developed a CRISPR/Cas9-based mouse model of SCLC by delivering an adenovirus (or an adeno-associated virus [AAV]) that expresses Cre recombinase and sgRNAs targeting , and into the lungs of Lox-Stop-Lox Cas9 mice. Coinclusion of a KDM5A sgRNA decreased SCLC tumorigenesis and metastasis, and the SCLCs that formed despite the absence of KDM5A had higher NOTCH activity compared to SCLCs. This work establishes a role for KDM5A in SCLC tumorigenesis and suggests that KDM5 inhibitors should be explored as treatments for SCLC.
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http://dx.doi.org/10.1101/gad.328336.119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942053PMC
December 2019

Anesthetic management of a patient with Steinert disease.

J Clin Anesth 2020 Feb 13;59:101-102. Epub 2019 Jul 13.

Department of Anesthesiology, Centro Hospitalar de Leiria, EPE, Leiria, Portugal.

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http://dx.doi.org/10.1016/j.jclinane.2019.06.016DOI Listing
February 2020

Cells Lacking the Tumor Suppressor Gene Are Hyperdependent on Aurora B Kinase for Survival.

Cancer Discov 2019 02 29;9(2):230-247. Epub 2018 Oct 29.

Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Small cell lung cancer (SCLC) accounts for 15% of lung cancers and is almost always linked to inactivating and mutations. SCLC frequently responds, albeit briefly, to chemotherapy. The canonical function of the gene product RB1 is to repress the E2F transcription factor family. RB1 also plays both E2F-dependent and E2F-independent mitotic roles. We performed a synthetic lethal CRISPR/Cas9 screen in an SCLC cell line that conditionally expresses to identify dependencies that are caused by RB1 loss and discovered that SCLC cell lines are hyperdependent on multiple proteins linked to chromosomal segregation, including Aurora B kinase. Moreover, we show that an Aurora B kinase inhibitor is efficacious in multiple preclinical SCLC models at concentrations that are well tolerated in mice. These results suggest that RB1 loss is a predictive biomarker for sensitivity to Aurora B kinase inhibitors in SCLC and perhaps other cancers. SIGNIFICANCE: SCLC is rarely associated with actionable protooncogene mutations. We did a CRISPR/Cas9-based screen that showed that SCLC are hyperdependent on , likely because both genes control mitotic fidelity, and confirmed that Aurora B kinase inhibitors are efficacious against SCLC tumors in mice at nontoxic doses...
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http://dx.doi.org/10.1158/2159-8290.CD-18-0389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368871PMC
February 2019

Methamphetamine Induces Anhedonic-Like Behavior and Impairs Frontal Cortical Energetics in Mice.

CNS Neurosci Ther 2017 Feb 19;23(2):119-126. Epub 2016 Oct 19.

Laboratory of Pharmacology and Experimental Therapeutics/Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Introduction: We recently showed that a single high dose of methamphetamine (METH) induces a persistent frontal cortical monoamine depletion that is accompanied by helpless-like behavior in mice. However, brain metabolic alterations underlying both neurochemical and mood alterations remain unknown.

Aims: Herein, we aimed at characterizing frontal cortical metabolic alterations associated with early negative mood behavior triggered by METH. Adult C57BL/6 mice were injected with METH (30 mg/kg, i.p.), and their frontal cortical metabolic status was characterized after probing their mood and anxiety-related phenotypes 3 days postinjection.

Results: Methamphetamine induced depressive-like behavior, as indicated by the decreased grooming time in the splash test and by a transient decrease in sucrose preference. At this time, METH did not alter anxiety-like behavior or motor functions. Depolarization-induced glucose uptake was reduced in frontocortical slices from METH-treated mice compared to controls. Consistently, astrocytic glucose transporter (GluT1) density was lower in the METH group. A proton high rotation magic angle spinning (HRMAS) spectroscopic approach revealed that METH induced a significant decrease in N-acetyl aspartate (NAA) and glutamate levels, suggesting that METH decreased neuronal glutamatergic function in frontal cortex.

Conclusions: We report, for the first time, that a single METH injection triggers early self-care and hedonic deficits and impairs frontal cortical energetics in mice.
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http://dx.doi.org/10.1111/cns.12649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492743PMC
February 2017

[Evaluation of the antimicrobial susceptibility of community-acquired urinary tract infection].

Acta Med Port 2014 Nov-Dec;27(6):737-42. Epub 2014 Dec 30.

ComissÉo de Controlo de InfeçÉo. Agrupamento de Centros de Saúde do Pinhal Litoral. Leiria. Portugal.

Introduction: The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal.

Material And Methods: We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%).

Results: Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin.

Discussion: Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%).

Conclusion: Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapyrecommendations for optimized therapeutical choices.
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December 2016

A Longitudinal Study of Well-being of Older Europeans: Does Retirement Matter?

J Popul Ageing 2014 Mar;7(1):21-41

University of California, Berkley and RAND.

We examine determinants of financial and subjective well-being, in particular poverty and depression, among older individuals in Europe. We do so using the 2004, 2006, and 2010 waves of the Survey of Health Ageing and Retirement in Europe and estimating dynamic panel data and binary choice transition models. We find a number of common effects across financial and subjective well-being. Unemployment, disabilities, serious health conditions, lower education, being female, and not being married increase the probability of poverty or depression. Conversely, healthy individuals, those with higher levels of education, males, and married individuals have higher probabilities of exiting poverty or depression. The effect of retirement is of special policy interest. It turns out to be crucial to control for endogeneity (i.e. the possibility of reverse causality) of retirement. If we don't control for endogeneity, retirement appears to increase both the risk of poverty and of depression. Once we control for endogeneity using instrumental variables, these negative effects disappear and point to weak evidence that retirement induced through eligibility for retirement pensions may be protective against poverty and depression.
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http://dx.doi.org/10.1007/s12062-014-9094-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979480PMC
March 2014

Dental anomalies in panoramic radiographs of pediatric patients.

Gen Dent 2013 Nov-Dec;61(7):e29-33

A panoramic radiograph is more likely utilized in children with high caries risk and mixed dentition, and it can be complemented by other X-rays (such as periapical and/or bitewings). This study analyzed 1359 panoramic radiographs taken over 33 years at the Pedodontics Clinic of the State University of Rio de Janeiro in order to determine the prevalence of dental anomalies in mixed dentition children. The population evaluated had 670 (49.3%) boys and 689 (50.7%) girls, ranging in age from 5-12 years, with a median age of 8 years. The total prevalence of anomalies detected was 11.72%; anodontia and supernumerary teeth were the most reported (4.63% and 3.31%, respectively). Statistical differences noted were in the presence of supernumary teeth in males (4.9%, P <.001) and the presence of anodontia in females (6.1%, P = .009). Based on these findings, a panoramic radiograph can help to analyze transitional dentition, as well as complement the clinical examination at the first dental visit of a pediatric patient with a high risk for caries.
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September 2015

What Explains the Gender Gap in Financial Literacy? The Role of Household Decision Making.

J Consum Aff 2012 ;46(1):90-106

Universite du Quebec a Montreal and Affiliate Adjunct at RAND.

Using newly collected data from the RAND American Life Panel, we examine potential explanations for the gender gap in financial literacy, including the role of marriage and who within a couple makes the financial decisions. Blinder-Oaxaca decomposition reveals the majority of the gender gap in financial literacy is not explained by differences in the characteristics of men and women-but rather differences in coefficients, or how literacy is produced. We find that financial decision making of couples is not centralized in one spouse although it is sensitive to the relative education level of spouses.
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http://dx.doi.org/10.1111/j.1745-6606.2011.01221.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462438PMC
January 2012

A health production model with endogenous retirement.

Health Econ 2013 Aug 6;22(8):883-902. Epub 2012 Aug 6.

RAND Corporation, Santa Monica, California, USA.

We formulate a stylized structural model of health, wealth accumulation and retirement decisions building on the human capital framework of health and derive analytic solutions for the time paths of consumption, health, health investment, savings and retirement. We argue that the literature has been unnecessarily restrictive in assuming that health is always at the 'optimal' health level. Exploring the properties of corner solutions, we find that advances in population health decrease the retirement age, whereas at the same time, individuals retire when their health has deteriorated. This potentially explains why retirees point to deteriorating health as an important reason for early retirement, whereas retirement ages have continued to fall in the developed world, despite continued improvements in population health and mortality. In our model, workers with higher human capital invest more in health and, because they stay healthier, retire later than those with lower human capital whose health deteriorates faster.
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http://dx.doi.org/10.1002/hec.2865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498590PMC
August 2013

An Analysis of the Labor Markets for Anesthesiology.

Rand Health Q 2011 1;1(3):18. Epub 2011 Sep 1.

The roughly 40,000 anesthesiologists (ANs) and anesthesiology residents and 39,000 licensed certified registered nurse anesthetists (CRNAs) and student CRNAs in the United States provide most anesthesiology services. Shortages in this critical area of health care can lead to problems in the provision of health services. The authors' surveys of ANs, CRNAs, and anesthesiology directors included questions about employer types, work hours, earnings, types of anesthesia provision, and technology adoption and preferences. They found a great deal of heterogeneity in work arrangements, clear urban/rural differences in the labor markets for anesthesiology, and even more-pronounced regional differences. In addition to the survey, demand-based and econometric analyses were conducted. The authors conclude that shortage of ANs and CRNAs is highly likely at the national level, with the survey approach providing hints of such a shortage and the economic analysis providing stronger confirmation. Finally, the authors examine the evolution of AN and CRNA labor markets up to 2020 under various scenarios.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945205PMC
September 2011

Refolding and purification of the human secreted group IID phospholipase A2 expressed as inclusion bodies in Escherichia coli.

Protein Expr Purif 2009 Oct 17;67(2):82-7. Epub 2009 Apr 17.

Department of Biochemistry and Immunology, FMRP-USP, Universidade de São Paulo, Brazil.

The secreted phospholipases A2 (sPLA2s) are water-soluble enzymes that bind to the surface of both artificial and biological lipid bilayers and hydrolyze the membrane phospholipids. The tissue expression pattern of the human group IID secretory phospholipase A2 (hsPLA2-IID) suggests that the enzyme is involved in the regulation of the immune and inflammatory responses. With an aim to establish an expression system for the hsPLA2-IID in Escherichia coli, the DNA-coding sequence for hsPLA2-IID was subcloned into the vector pET3a, and expressed as inclusion bodies in E. coli (BL21). A protocol has been developed to refold the recombinant protein in the presence of guanidinium hydrochloride, using a size-exclusion chromatography matrix followed by dilution and dialysis to remove the excess denaturant. After purification by cation-exchange chromatography, far ultraviolet circular dichroism spectra of the recombinant hsPLA2-IID indicated protein secondary structure content similar to the homologous human group IIA secretory phospholipase A2. The refolded recombinant hsPLA2-IID demonstrated Ca(2+)-dependent hydrolytic activity, as measuring the release free fatty acid from phospholipid liposomes. This protein expression and purification system may be useful for site-directed mutagenesis experiments of the hsPLA2-IID which will advance our understanding of the structure-function relationship and biological effects of the protein.
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http://dx.doi.org/10.1016/j.pep.2009.04.006DOI Listing
October 2009