Impact of the primary care residents on the productivity of the ambulatory health centres in Portugal: a cross-sectional study.

BACKGROUND: The presence of residents in Primary Care health centres may influence their operational results. AIM: To examine the relationship between the presence of residents and the results of the evaluation in Portuguese Primary Care Health Centres. METHODS: We conduct a cross-sectional study, comparing the results achieved by the mainland Portuguese Primary Care Health Centres measured by the Global Performance Index (Índice de desempenho global - IDG) by the presence of General & Family Medicine residents in training. Analysis took into consideration the distribution by region and typology of the health centres. RESULTS: We evaluated 906 units, 55.7% involved in the training of General & Family Medicine residence. The presence of residents was associated with higher Global Performance Index values (77.3 vs 57.6; p < 0.001). The higher difference was found in the less developed Personalized Health Care Units and in the region of Lisbon and Tagus Valley. CONCLUSION: The presence of residents in training is a contributing factor in the productivity of the Primary Health Care facilities. It may model the asymmetry in the performance of Portuguese Health Centres.

Bioreactor-based 3D human myocardial ischemia/reperfusion in vitro model: a novel tool to unveil key paracrine factors upon acute myocardial infarction.

During acute myocardial infarction (AMI), Ischemia/Reperfusion (I/R) injury causes cardiomyocyte (CM) death and loss of tissue function, making AMI one of the major causes of death worldwide. Cell-based in vitro models of I/R injury have been increasingly used as a complementary approach to preclinical research. However, most approaches use murine cells in 2D culture setups, which are not able to recapitulate human cellular physiology, as well as nutrient and gas gradients occurring in the myocardium. In this work we established a novel human in vitro model of myocardial I/R injury using CMs derived from human induced pluripotent stem cells (hiPSC-CMs), which were cultured as 3D aggregates in stirred tank bioreactors. We were able to recapitulate important hallmarks of AMI, including loss of CM viability with disruption of cellular ultrastructure, increased angiogenic potential, and secretion of key proangiogenic and proinflammatory cytokines. Conditioned medium was further used to probe human cardiac progenitor cells (hCPCs) response to paracrine cues from injured hiPSC-CMs through quantitative whole proteome analysis (SWATH-MS). I/R injury hiPSC-CM conditioned media incubation caused upregulation of hCPC proteins associated with migration, proliferation, paracrine signaling, and stress response-related pathways, when compared to the control media incubation. Our results indicate that the model developed herein can serve as a novel tool to interrogate mechanisms of action of human cardiac populations upon AMI.