Measuring the value of solidarity: The abem financial assistance program for out-of-pocket payments on pharmacy medicines in Portugal.

OBJECTIVE: Out-of-pocket payments for prescribed medicines are still comparatively high in Portugal. The abem program was launched in Portugal in May 2016 to aid vulnerable groups by completely covering out-of-pocket costs of prescribed medicines in community pharmacies. This study assesses the impact of the program on poverty and catastrophic health expenditures. METHODS: A longitudinal study was carried out with the analysis of several program databases (from the beginning of the program in May 2016 to September 2018) covering the cohorts of beneficiaries, daily data on medicines dispensed, social referencing entities, and solidarity pharmacies. The study provides estimates of standard poverty measures (intensity and severity) as well as the incidence of catastrophic health expenditures. RESULTS: More than 6000 beneficiaries were supported (56.8% female, 34.7% aged 65 or over), encompassing 127,510 medicines (mainly nervous system and cardiovascular system) with an average 26.9% co-payment (payments totalling €1.5 million). The program achieved substantial reductions in poverty (3.4% in intensity, 5.6% in severity), and eliminated cases with catastrophic health expenditures in medicines that would have affected 7.5% of the beneficiaries. CONCLUSIONS: Findings confirm a continuous increase in the number of beneficiaries, enabling access to medicines especially for the vulnerable elderly, and a sizable impact on eliminating out-of-pocket payments for medicines in the target population.

Patient preferences and cost-benefit of hypertension and hyperlipidemia collaborative management model between pharmacies and primary care in Portugal: A discrete choice experiment alongside a trial (USFarmácia®).

BACKGROUND: Little is known about patient preferences and the value of pharmacy-collaborative disease management with primary care using technology-driven interprofessional communication under real-world conditions. Discrete Choice Experiments (DCEs) are useful for quantifying preferences for non-market services. OBJECTIVES: 1) To explore variation in patient preferences and estimate willingness-to-accept annual cost to the National Health Service (NHS) for attributes of a collaborative intervention trial between pharmacies and primary care using a trial exit DCE interview; 2) to incorporate a DCE into an economic evaluation using cost-benefit analysis (CBA). METHODS: We performed a DCE telephone interview with a sample of hypertension and hyperlipidemia trial patients 12 months after trial onset. We used five attributes (levels): waiting time to get urgent/not urgent medical appointment (7 days/45 days; 48 hrs./30 days; same day/15 days), model of pharmacy intervention (5-min. counter basic check; 15-min. office every 3 months for BP and medication review of selected medicines; 30-min. office every 6 months for comprehensive measurements and medication review of all medicines), integration with primary care (weak; partial; full), chance of having a stroke in 5 years (same; slightly lower; much lower), and annual cost to the NHS (0€; 30€; 51€; 76€). We used an experimental orthogonal fractional factorial design. Data were analyzed using conditional logit. We subtracted the estimated annual incremental trial costs from the mean WTA (Net Benefit) for CBA. RESULTS: A total of 122 patients completed the survey. Waiting time to get medical appointment-on the same day (urgent) and within 15 days (non-urgent)-was the most important attribute, followed by 30-minute pharmacy intervention in private office every 6 months for point-of-care measurements and medication review of all medicines, and full integration with primary care. The cost attribute was not significant. Intervention patients were willing to accept the NHS annual cost of €877 for their preferred scenario. The annual net benefit per patient is €788.20 and represents the monetary value of patients' welfare surplus for this model. CONCLUSIONS: This study is the first conducted in Portugal alongside a pharmacy collaborative trial, incorporating DCE into CBA. The findings can be used to guide the design of pharmacy collaborative interventions with primary care with the potential for reimbursement for uncontrolled or at-risk chronic disease patients informed by patient preferences. Future DCE studies conducted in community pharmacy may provide additional contributions. TRIAL REGISTRATION: Current Controlled Trials (ISRCTN): ISRCTN13410498, retrospectively registered on 12 December 2018.

Healthcare Professionals' Resilience During the COVID-19 and Organizational Factors That Improve Individual Resilience: A Mixed-Method Study.

Healthcare workers are a susceptible population to be psychologically affected during health crises, such as the recent COVID-19 pandemic. Resilience has been pointed out in the literature as a possible protective factor against psychological distress in crisis situations. This can be influenced by internal and external factors, such as individual characteristics and organizational factors. Thus, this study aims to characterize the overall resilience levels among healthcare professionals in Portugal and to understand the perspectives of this healthcare workers regarding organizational factors that improve individual resilience. This is a mixed-method study: a first quantitative study using a cross-sectional design to administer the Resilience Scale for Adults (RSA) to 271 healthcare professionals (Mage 33.90, SD = 9.59 years, 90.80% female), followed by a qualitative study through 10 in-depth interviews. The mean score for the total RSA was 178.17 (SD = 22.44) out of a total of 231. Qualitative analysis showed 4 major themes on factors that enhance resilience: "Professional's Training," "Support and Wellbeing Measures," "Reorganization of Services" and "Professional Acknowledgment." The findings may contribute to the development of targeted interventions and support systems to enhance resilience and well-being among healthcare workers.

Green Antimicrobials as Therapeutic Agents for Diabetic Foot Ulcers.

Diabetic foot ulcers (DFU) are one of the most serious and devastating complications of diabetes and account for a significant decrease in quality of life and costly healthcare expenses worldwide. This condition affects around 15% of diabetic patients and is one of the leading causes of lower limb amputations. DFUs generally present poor clinical outcomes, mainly due to the impaired healing process and the elevated risk of microbial infections which leads to tissue damage. Nowadays, antimicrobial resistance poses a rising threat to global health, thus hampering DFU treatment and care. Faced with this reality, it is pivotal to find greener and less environmentally impactful alternatives for fighting these resistant microbes. Antimicrobial peptides are small molecules that play a crucial role in the innate immune system of the host and can be found in nature. Some of these molecules have shown broad-spectrum antimicrobial properties and wound-healing activity, making them good potential therapeutic compounds to treat DFUs. This review aims to describe antimicrobial peptides derived from green, eco-friendly processes that can be used as potential therapeutic compounds to treat DFUs, thereby granting a better quality of life to patients and their families while protecting our fundamental bio-resources.

The Use of a Polylactic Membrane in Pediatric Burns Proves to be Successful Even After Late Application.

The Polylactide membrane (PLM) is a biosynthetic dressing that mimics properties of the human epithelium. Herein we describe our experience on the use of PLM in pediatric burns. All pediatric burn patients admitted to the Pediatric Surgery Department between November 2019 and November 2021 and submitted to PLM application were selected. Clinical and demographic data were collected retrospectively. Seventy-seven patients with a median age of 1.8 years were included. The median total body surface area was 6% (2-20%), and burns were mainly mixed-partial thickness. PLM was applied at a median of 5 days post-burn (IQR 3-6), usually under sedation (43/77). After PLM application, the median healing time (HT) was 10 days (IQR 8-14). HT was significantly higher in deep-partial thickness burns vs. mixed superficial-deep (P = .015) and superficial burn areas (P = .006). No correlation was found between HT and the timing of PLM application. The grafting rate due to clinical misevaluation was 2.7%, one infection was found. The PLM is a promising way for treating partial-thickness burns, even when applied later during treatment. Shorter HT, the decreased need for dressing changes, and the potential of sparing of donor sites and pain reduction are its main advantages.

Point-of-care HIV and hepatitis screening in community pharmacies: a quantitative and qualitative study.

BACKGROUND: Point-of-care tests can contribute to earlier diagnosis and treatment of infectious diseases, thereby affording the opportunity to prevent chronic stages and the spread to others. As part of the Fast-Track Cities initiative, a pilot study was initiated in community pharmacies in Portugal. AIM: To characterize the individuals choosing to have point-of-care testing or screening for human immunodeficiency virus, hepatitis C, and hepatitis B virus infections in community pharmacies, their risk behaviours and motivations to perform the tests, as well as to understand the facilitators and barriers from the perspective of pharmacists. METHOD: A quantitative and qualitative study was conducted. A survey was applied to test users in pharmacies between May and December 2019, and three focus groups were conducted with six, four, and five pharmacists involved in the initiative. Qualitative data were analysed according to thematic content analysis. RESULTS: A total of 210 questionnaires were collected (57.9% response rate). Point-of-care test users were predominantly male, mean age of 35 (± 13.0) years, the majority had higher education level, and 22.8% were born outside of Portugal. Almost half of the users were first time tested and the main reason for screening was unprotected sexual intercourse. Pharmacists identified speed, confidentiality, counselling provided to users, pharmacists' initial training to perform the tests, and trust in the pharmacist as facilitators of these tests. Stigma associated with infections, the procedure, logistical conditions, and the referral process were considered as barriers. CONCLUSION: Pharmacies are a screening site with special importance for individuals who are first tested, heterosexuals, and some migrants. Nevertheless, it is necessary to understand and reduce barriers and increase the support to specific groups.

Cost-effectiveness and cost-utility of hypertension and hyperlipidemia collaborative management between pharmacies and primary care in portugal alongside a trial compared with usual care (USFarmácia®).

Background: There is little experience in the economic evaluation of pharmacy/primary care collaborative health interventions using interprofessional technology-driven communication under real-world conditions. This study aimed to conduct cost-effectiveness and cost-utility analyses of a collaborative care intervention in hypertension and hyperlipidemia management between pharmacies and primary care versus usual (fragmented) care alongside a trial. Methods: An economic evaluation was conducted alongside a 6-month pragmatic quasi-experimental controlled trial. Data sources included primary care clinical software; pharmacy dispensing software; patient telephone surveys; and published literature. The target population was adult patients on hypertension and/or lipid-lowering medication. The perspective was societal. We collected patient-level data on resource use to estimate trial costs. Effect outcomes included blood pressure (BP) and quality-adjusted life years (QALYs). Bootstrapping was used to estimate uncertainty around the incremental cost-effectiveness and cost-utility ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: The intervention was not shown to have reasonable levels of cost-effectiveness or cost-utility when compared to usual care as denoted by the levels of uncertainty expressed in wide confidence intervals. The probability of the intervention being cost-effective is 28% at the threshold of €20,000 per QALY gained and 57% at the threshold of €500 per mmHg systolic BP decrease. Conclusion: Considering the limitations of the trial which affected effectiveness and economic outcomes, our results are not generalizable for community pharmacy and primary care in Portugal. This research offers, however, valuable lessons on methods and strategies that can be used in future economic evaluations of collaborative public health interventions with the potential for reimbursement. Clinical trial registration: https://www.isrctn.com/ISRCTN13410498, identifier ISRCTN13410498.

Improving word embeddings in Portuguese: increasing accuracy while reducing the size of the corpus.

The subjectiveness of multimedia content description has a strong negative impact on tag-based information retrieval. In our work, we propose enhancing available descriptions by adding semantically related tags. To cope with this objective, we use a word embedding technique based on the Word2Vec neural network parameterized and trained using a new dataset built from online newspapers. A large number of news stories was scraped and pre-processed to build a new dataset. Our target language is Portuguese, one of the most spoken languages worldwide. The results achieved significantly outperform similar existing solutions developed in the scope of different languages, including Portuguese. Contributions include also an online application and API available for external use. Although the presented work has been designed to enhance multimedia content annotation, it can be used in several other application areas.

Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques.

BACKGROUND: Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL). METHODS: All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. RESULTS: One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03). CONCLUSIONS: MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.

Real-World Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies During the COVID-19 Pandemic.

OBJECTIVES: In Portugal, the dispensing of most outpatient specialty medicines is performed exclusively through hospital pharmacies and totally financed by the National Health Service. During the COVID-19 first wave, the government allowed the transfer of the dispensing of hospital-only medicines (HOMs) to community pharmacies (CPs). This study aimed to measure the value generated by the intervention of CP in the dispensing of HOM. METHODS: A single-arm, before-and-after study with 3-month follow-up was conducted enrolling a randomly selected sample of patients or caregivers with at least 1 dispensation of HOM through CP. Data were collected by telephone interview. Main outcomes were patients' self-reported adherence (Measure Treatment Adherence), health-related quality of life (EQ-5D 3-Level), satisfaction with the service, and costs related to HOM access. RESULTS: Overall 603 subjects were recruited to participate in the study (males 50.6%) with mean 55 years old (SD = 16). The already high mean adherence score to therapy improved significantly (P < .0001), and no statistically significant change (P > .5757) was found in the mean EQ-5D score between baseline (0.7 ± 0.3) and 3-month follow-up (0.8 ± 0.3). Annual savings account for €262.1/person, arising from travel expenses and absenteeism reduction. Participants reported a significant increase in satisfaction levels in all evaluated domains-pharmacist's availability, opening hours, waiting time, privacy conditions, and overall experience. CONCLUSIONS: Changing the dispense setting to CP may promote better access and satisfaction. Moreover, it ensures the persistence of treatments, promotes savings for citizens, and reduces the burden of healthcare services, representing a crucial public health measure.

Photo2Video: Semantic-Aware Deep Learning-Based Video Generation from Still Content.

Applying machine learning (ML), and especially deep learning, to understand visual content is becoming common practice in many application areas. However, little attention has been given to its use within the multimedia creative domain. It is true that ML is already popular for content creation, but the progress achieved so far addresses essentially textual content or the identification and selection of specific types of content. A wealth of possibilities are yet to be explored by bringing the use of ML into the multimedia creative process, allowing the knowledge inferred by the former to influence automatically how new multimedia content is created. The work presented in this article provides contributions in three distinct ways towards this goal: firstly, it proposes a methodology to re-train popular neural network models in identifying new thematic concepts in static visual content and attaching meaningful annotations to the detected regions of interest; secondly, it presents varied visual digital effects and corresponding tools that can be automatically called upon to apply such effects in a previously analyzed photo; thirdly, it defines a complete automated creative workflow, from the acquisition of a photograph and corresponding contextual data, through the ML region-based annotation, to the automatic application of digital effects and generation of a semantically aware multimedia story driven by the previously derived situational and visual contextual data. Additionally, it presents a variant of this automated workflow by offering to the user the possibility of manipulating the automatic annotations in an assisted manner. The final aim is to transform a static digital photo into a short video clip, taking into account the information acquired. The final result strongly contrasts with current standard approaches of creating random movements, by implementing an intelligent content- and context-aware video.

[Pre-Exposure Prophylaxis for Human Immunodeficiency Virus in the Medical Curricula in Portugal: A Cross-Sectional Analysis].

INTRODUCTION: Pre-exposure prophylaxis (PrEP) has gained relevance as a method of prevention for HIV in certain people and settings. Following the publication of the guideline on PrEP prescribing in Portugal, we aimed to assess the knowledge of Portuguese Medical Students about PrEP. MATERIAL AND METHODS: An online survey was sent to Medical students of Portuguese Medical Schools. We conducted a descriptive analysis of the results and an analytic cross-sectional study to identify factors associated with "knowing about PrEP", "having had one class about PrEP" and "identifying eligible groups correctly". RESULTS: Of the 796 students that responded to the survey, 64.6% were aware of what PrEP is. Of these, 34.44% acquired this knowledge during their training. Out of the total amount of respondents, 4.77% could identify correctly and completely the eligible groups for PrEP. As the training years went by, the probability of being aware of PrEP, having had one class about PrEP, and identifying the eligible groups correctly, increased. Of the sixth-year students, 43.48% had had one class about PrEP and among the students that were aware of PrEP, 28% identified what the eligible groups were. After adjusting for the school year, we found differences between Medical Schools regarding the outcomes. The association between the different ways of learning about PrEP and the ability to correctly identify eligible groups for PrEP was not statistically significant. CONCLUSION: The differences between Medical Schools could be harmonized through changes in the medical curricula that would allow this topic to be addressed more often.

Introdução: A profilaxia pré-exposição (PrEP) ganhou relevância como método de prevenção do VIH em determinados indivíduos e contextos. Após a entrada em vigor das normas para prescrição em Portugal, pretendemos aferir o conhecimento em relação à PrEP entre os estudantes de Medicina em Portugal.Material e Métodos: Foi enviado um questionário online aos estudantes de Medicina das escolas médicas portuguesas. Foi feita uma análise descritiva dos resultados e um estudo transversal analítico para identificar fatores associados a "conhecer a PrEP", "ter tido uma aula de PrEP", e "identificar grupos elegíveis corretamente".Resultados: Dos 796 estudantes que responderam, 64,6% sabiam o que era a PrEP. Destes, 34,44% obteve conhecimento sobre a mesma durante a sua formação. Entre os respondentes, 4,77% identificaram correta e completamente os grupos elegíveis. Com o avançar do ano letivo, a probabilidade de conhecer a PrEP, ter tido uma aula de PrEP e identificar os grupos corretamente aumentava. No sexto ano, 43,48% tinham tido uma aula sobre PrEP e entre os que conheciam a PrEP, 28% identificaram os grupos elegíveis. Existem diferenças entre as escolas médicas após ajustamento para o ano letivo em relação aos resultados obtidos. A forma como se tomou conhecimento da PrEP não alterou de forma estatisticamente significativa a capacidade de identificar corretamente grupos elegíveisConclusão: As diferenças entre as escolas médicas poderão ser harmonizadas. Esta temática poderá ser reforçada nos respetivos currículos.

Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations.

BACKGROUND: Deprescribing can reduce the use of inappropriate or unnecessary medication; however, the economic value of such interventions is uncertain. OBJECTIVE: This study seeks to identify and synthetise the economic evidence of deprescribing interventions among community-dwelling older adults. METHODS: Full economic evaluation studies of deprescribing interventions, conducted in the community or primary care settings, in community-dwelling adults aged ≥ 65 years were systematically reviewed. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Two researchers independently screened all retrieved articles according to inclusion and exclusion criteria. The main outcome was the economic impact of the intervention from any perspective, converted into 2019 US Dollars. The World Health Organization threshold of 1 gross domestic product per capita was used to define cost effectiveness. Studies were appraised for methodological quality using the extended Consensus on Health Economics Criteria checklist. RESULTS: Of 6154 articles identified by the search strategy, 14 papers assessing 13 different interventions were included. Most deprescribing interventions included some type of medication review with or without a supportive educational component (n = 11, 85%), and in general were delivered within a pharmacist-physician care collaboration. Settings included community pharmacies, primary care/outpatient clinics and patients' homes. All economic evaluations were conducted within a time horizon varying from 2 to 12 months with outcomes in most of the studies derived from a single clinical trial. Main health outcomes were reported in terms of quality-adjusted life-years, prevented number of falls and the medication appropriateness index. Cost effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932 per quality-adjusted life-year, a value above the country's World Health Organization threshold. Overall, 85% of the interventions were cost saving, dominated usual care or were cost effective considering 1 gross domestic product per capita. Nine studies scored > 80% (good) and two scored ≤ 50% (low) on critical quality appraisal. CONCLUSIONS: There is a growing interest in economic evaluations of deprescribing interventions focused on community-dwelling older adults. Although results varied across setting, time horizon and intervention, most were cost effective according to the World Health Organization threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.

Corrigendum to "Ectopic breast tissue presenting as an enlarging abdominal mass" [Radiology Case Reports 15 (2020) 733-740].

[This corrects the article DOI: 10.1016/j.radcr.2020.02.028.].

Ectopic breast tissue presenting as an enlarging abdominal mass.

Ectopic breast tissue (EBT) is an uncommon entity that occurs in about 6% of the population, more frequently in Asian people. It manifests as a nonspecific soft tissue mass that can develop in any location along the "milk-line," with the axilla being the most frequently reported location. As with normal breast tissue, both benign and malignant processes can arise from EBT. Therefore, imaging plays an important role in the adequate assessment of these soft tissue lesions, characterizing its shape, borders, internal components, and vascularity, as well as its relationship with the deep fascia and adjacent structures. Here we present a case of a 33-year-old female Indian patient with an 8 cm soft tissue mass in the upper left abdominal quadrant with a recent increase in size. Clinical and imagiological evaluation were nonspecific but established the nonaggressive behavior of the lesion. To ultimately exclude malignancy, an ultrasound-guided biopsy was performed providing the histological diagnosis of EBT. This case report illustrates the value of clinical, radiological, and histological correlation in the approach of indeterminate soft-tissue tumors, with special focus on lesions in close proximity to the native breasts, where EBT should not be forgotten amongst differentials.

Giant multilocular prostatic cystadenoma, a diagnosis to consider in large pelvic male masses.

Giant multilocular prostatic cystadenomas are rare benign prostatic tumor, usually presenting as a large pelvic mass, compressing the adjacent organs but with no clear aggressive features, frequently causing obstructive voiding symptoms. Nowadays, imaging plays an important role on the adequate characterization of these lesions, not only on depicting their different internal components, but also the relationship with the adjacent structures, therefore providing the best preoperative surgical planning. Here we present a case of a 62-year-old patient with recurrent obstructive voiding symptoms due to a giant multilocular prostatic cystadenomas, with histologically correlation, posteriorly excised.

Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) System for Outcome Prediction in Elderly Patients Undergoing Major Vascular Surgery.

OBJECTIVE: POSSUM system is widely used and validated for 30-day mortality and morbidity prediction. The aim of this study was to evaluate the performance of five POSSUM's equations (POSSUM, P-POSSUM, V-POSSUM, V-POSSUM physiology and V-POSSUM Cambridge) on predicting 30-day mortality and morbidity in elderly patients undergoing major elective vascular surgery. DESIGN: A retrospective longitudinal cohort study. SETTING: A study conducted at an University Hospital. PARTICIPANTS: 208 elderly patients (≥ 60 years) undergoing major elective vascular surgery. MEASUREMENTS: Data collected from the clinical files included patient's characteristics, diagnosis, surgery, comorbidities, parameters from POSSUM score, 30, 60 and 90-day mortality and 30-day morbidity. POSSUM system's goodness-of-fit for predicting mortality and morbidity was assessed by Hosmer-Lemeshow test (H-L T) and Standardized Mortality/Morbidity Ratio (SMR) and discriminative ability by the area under the ROC curves (ROC-AUC). Patients' average age was 70.8 years, 81% males. INTERVENTIONS: None. MAIN RESULTS: The overall 30-day mortality rate was 2.97% (n=6) and 30-day morbidity was 29.2% (n=59). POSSUM, P-POSSUM, V-POSSUM, V-POSSUM physiology and V-POSSUM Cambridge equation predicted an overall of 29.1, 4.43, 15.3, 21.9 and 13.5 deaths, respectively. POSSUM morbidity equation predicted 105.0 complications. H-LT p-values were 0.001, 0.164, 0.208, 0.011, 0.331 and <0.001, respectively. SMRs and 95% confidence interval (CI) were 0.21[0.04-0.37], 1.35[0.27-2.44], 0.39[0.08-0.71], 0.27[0.06-0.49], 0.44[0.09-0.80] and 0.56[0.42-0.71], respectively. ROC-AUC and 95% CI were 0.72[0.49-0.95], 0.72[0.49-0.95], 0.73[0.51-0.94], 0.69[0.50-0.89], 0.72[0.52-0.92] and 0.71[0.63-0.79], respectively. CONCLUSIONS: P-POSSUM had the best performance predicting 30-day mortality. All the other overestimated 30-day mortality. Prediction of morbidity was inadequate. POSSUM scoring models may not be robust tools for risk prediction in elderly patients undergoing major elective vascular surgery and need further calibration and discrimination.

Social and economic value of Portuguese community pharmacies in health care.

BACKGROUND: Community pharmacies are major contributors to health care systems across the world. Several studies have been conducted to evaluate community pharmacies services in health care. The purpose of this study was to estimate the social and economic benefits of current and potential future community pharmacies services provided by pharmacists in health care in Portugal. METHODS: The social and economic value of community pharmacies services was estimated through a decision-model. Model inputs included effectiveness data, quality of life (QoL) and health resource consumption, obtained though literature review and adapted to Portuguese reality by an expert panel. The estimated economic value was the result of non-remunerated pharmaceutical services plus health resource consumption potentially avoided. Social and economic value of community pharmacies services derives from the comparison of two scenarios: "with service" versus "without service". RESULTS: It is estimated that current community pharmacies services in Portugal provide a gain in QoL of 8.3% and an economic value of 879.6 million euros (M€), including 342.1 M€ in non-remunerated pharmaceutical services and 448.1 M€ in avoided expense with health resource consumption. Potential future community pharmacies services may provide an additional increase of 6.9% in QoL and be associated with an economic value of 144.8 M€: 120.3 M€ in non-remunerated services and 24.5 M€ in potential savings with health resource consumption. CONCLUSIONS: Community pharmacies services provide considerable benefit in QoL and economic value. An increase range of services including a greater integration in primary and secondary care, among other transversal services, may add further social and economic value to the society.

SUMOylation Inhibition Mediated by Disruption of SUMO E1-E2 Interactions Confers Plant Susceptibility to Necrotrophic Fungal Pathogens.

Protein modification by SUMO modulates essential biological processes in eukaryotes. SUMOylation is facilitated by sequential action of the E1-activating, E2-conjugating, and E3-ligase enzymes. In plants, SUMO regulates plant development and stress responses, which are key determinants in agricultural productivity. To generate additional tools for advancing our knowledge about the SUMO biology, we have developed a strategy for inhibiting in vivo SUMO conjugation based on disruption of SUMO E1-E2 interactions through expression of E1 SAE2UFDCt domain. Targeted mutagenesis and phylogenetic analyses revealed that this inhibition involves a short motif in SAE2UFDCt highly divergent across kingdoms. Transgenic plants expressing the SAE2UFDCt domain displayed dose-dependent inhibition of SUMO conjugation, and have revealed the existence of a post-transcriptional mechanism that regulates SUMO E2 conjugating enzyme levels. Interestingly, these transgenic plants displayed increased susceptibility to necrotrophic fungal infections by Botrytis cinerea and Plectosphaerella cucumerina. Early after fungal inoculation, host SUMO conjugation was post-transcriptionally downregulated, suggesting that targeting SUMOylation machinery could constitute a novel mechanism for fungal pathogenicity. These findings support the role of SUMOylation as a mechanism involved in plant protection from environmental stresses. In addition, the strategy for inhibiting SUMO conjugation in vivo described in this study might be applicable in important crop plants and other non-plant organisms regardless of their genetic complexity.