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1.
Sci Total Environ ; 855: 158898, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36150595

RESUMO

Aquaculture is one of the fastest growing sectors in the world. However, this may come with a cost, as increasing aquatic production is likely to impose changes in the environment. To ensure ecosystem sustainability, it is essential to think on this larger scale. This study aims to use the Delft3D model suite to evaluate the ecological carrying capacity for bivalve production in the Sado Estuary (Portugal), under present and future conditions (2050). Scenarios for increased oyster production resulted in reductions of chlorophyll a associated with increased nutrient concentrations. In the most extreme production scenario, which considered an increase of 100 ha in production area, a predicted decrease of 90 % in phytoplankton biomass was observed. Climate change (CC) was incorporated as an increase in sea level and water temperature, as well as a reduction in river flow. Under present oyster production conditions, CC revealed contrasting patterns, i.e. an increase in chlorophyll a concentrations and a reduction in nutrients. These results suggest that CC has a positive effect in counteracting the impacts of increased oyster production, however further research is necessary. All scenarios point to reduced dissolved oxygen concentrations, highlighting the need to monitor this parameter. Given the difficulty in defining what are unacceptable impacts to the ecosystem it would be prudent to include a socio-ecological framework in the future, in order to integrate ecosystem services and the perception of local stakeholders.


Assuntos
Ecossistema , Ostreidae , Animais , Estuários , Clorofila A , Portugal , Aquicultura
2.
JBI Evid Implement ; 20(S1): S76-S87, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36372796

RESUMO

OBJECTIVES: To implement evidence-based practice related to care and flushing of nasogastric tubes inserted for feeding, in a general medicine ward. INTRODUCTION: Nasogastric tube feeding is a widely used nutritional support form. Although performed by qualified professionals, it is not a harm-free intervention. Progression to the trachea during initial insertion, aspiration of gastric contents, improper position for patient feeding, and/or a blocked tube are examples of problems that can occur. METHODS: The project used JBI's methodological approach of the Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit focused on nursing procedures related to the maintenance of nasogastric tube feeding, based on 14 criteria informed by the JBI evidence summaries, was performed for a month. Education sessions and other engagement strategies and resources were used to increase nasogastric tube maintenance. This best-practice implementation was conducted in Portugal, between January 2020 and April 2021, in a 33-bed general medicine ward with a staff of 30 registered nurses. RESULTS: Different samples, for each audited procedure, were obtained from a universe of 25 nurses and 14 episodes of patients with nasogastric tube in baseline and 10 in follow-up audit. At baseline, compliance with the criteria ranged from 0 to 88%. Ten of the 14 criteria were below 50%. The follow-up audit showed significant improvement in all compliance criteria (ranging from 44.4 to 100%). Criteria 1 and 2, which were aimed at preventing adverse consequences related to wrong placement or displacement of the nasogastric tube, showed a high postimplementation compliance level (89.3 and 90%). CONCLUSION: With an integrated plan incorporating interventions, strategies, and resources, tailored for this context, we improved nurses' knowledge of nasogastric tube maintenance and achieved significantly increased compliance with nasogastric tube care best-practice. We suggest maintaining current strategies, and reinforcing clinical supervision and regular assessment.


Assuntos
Competência Clínica , Intubação Gastrointestinal , Humanos , Portugal , Prática Clínica Baseada em Evidências
3.
Nutrients ; 14(21)2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36364754

RESUMO

The goal of this work was to examine whether elevated iodine intake was associated with adverse effects on IQ among school-age children in Portugal. In a representative sample of children from the north of the country, IQ percentiles by age (assessed with Raven's Colored Progressive Matrices) were dichotomized to <50 ("below-average" IQs) and ≥50. Morning urine iodine concentrations, corrected for creatinine, were dichotomized to <250 µg/g and ≥250 µg/g, according to the European Commission/Scientific Committee on Food's tolerable upper level of daily iodine intake for young children. Data were examined with Chi-square tests, logistic regression, and GLM univariate analysis. The sample (N = 1965) was classified as generally iodine-adequate (median urinary iodine concentration = 129 µg/L; median iodine-to-creatinine ratio = 126 µg/g) according to the WHO's criteria. A greater proportion of children in the ≥250 µg/g group had below-average IQs, compared to children with less than 250 µg/g (p = 0.037), despite a sizable (though non-significant) proportion of children in the less-than-250 µg/g group also presenting below-average IQs, at the bottom of the iodine distribution (<50 µg/g). The proportion of below-average IQs increased with increasingly elevated iodine concentrations (p = 0.047). The association remained significant after the adjustment for confounders, with the elevated iodine group showing increased odds of having below-average IQs when compared with the non-elevated iodine group (OR 1.55; 95% CI 1.11-2.17; p = 0.011). Consistently, the former group presented a lower mean IQ than the latter (p = 0.006). High iodine intake was associated with lower IQs even in a population classified as iodine-adequate. These results bear on child cognition and on initiatives involving iodine supplementation.


Assuntos
Iodo , Criança , Humanos , Pré-Escolar , Creatinina/urina , Portugal , Iodo/urina , Estado Nutricional , Testes de Inteligência , Iodetos
4.
Nutrients ; 14(21)2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36364838

RESUMO

The bioactivity of natural by-products in food and pharmaceutical applications is the subject of numerous studies. Cherry production and processing generates large amounts of biowaste, most of which is not used. The recovery of these by-products is essential for promoting the circular economy and to improving sustainability in the food industry. In this work, we explored the anti-inflammatory and antimicrobial potential of two different extracts from stems, leaves, and flowers of Portuguese cherries. The anti-inflammatory potential was studied on lipopolysaccharide (LPS)-stimulated mouse macrophages (RAW 264.7) by evaluating the effect of by-products on cellular viability and nitric oxide (NO) production. Disc diffusion and minimum inhibitory concentration (MIC) were used to determine antimicrobial activity. The cherry by-products had no cytotoxic effect on RAW 264.7 cells, and were able to inhibit nitrite production in a dose-dependent manner. Moreover, all aqueous infusions showed good antioxidant activity against NO radicals. Moreover, leaf extracts showed the best activity against most of the strains studied. The results revealed, for the first time, interesting anti-inflammatory and antimicrobial properties of cherry by-products. This could potentially be of interest for their therapeutic use in the treatment of inflammation-related diseases or in controlling the growth of microorganisms.


Assuntos
Anti-Infecciosos , Prunus avium , Camundongos , Animais , Extratos Vegetais/farmacologia , Portugal , Anti-Inflamatórios/farmacologia , Anti-Infecciosos/farmacologia
5.
Sci Rep ; 12(1): 19335, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36369296

RESUMO

Ferric carboxymaltose (FCM) can be used in Patient Blood Management (PBM) to promote the optimization of preoperative haemoglobin (Hb), which aims to minimise the use of allogeneic blood components and improve clinical outcomes, with better cost-effectiveness. This was an observational study conducted in a retrospective and multicentre cohort with adults from elective orthopaedic, cardiac and colorectal surgeries, treated according to local standards of PBM with allogeneic blood product transfusions (ABTs) on demand and with FCM to correct iron deficiency with or without anaemia. In this work, only the first pillar of the PBM model issue by Directorate-General for Health (DGS) was evaluated, which involves optimising Hb in the preoperative period with iron treatment if it's necessary/indicated. Before the implementation of PBM in Portugal, most patients did not undergo preoperative laboratory evaluation with blood count and iron kinetics. Therefore, the existence of Iron Deficiency Anaemia (IDA) or Iron Deficiency (ID) without anaemia was not early detected, and there was no possibility of treating these patients with iron in order to optimise their Hb and/or iron stores. Those patients ended up being treated with ABTs on demand. A total of 405 patients from seven hospitals were included; 108 (26.7%) underwent FCM preoperatively and 197 (48.6%) were transfused with ABTs on demand. In the FCM preoperative cohort, there was an increase in patients with normal preoperative Hb, from 14.4 to 45.7%, before and after FCM, respectively, a decrease from 31.7 to 9.6% in moderate anaemia and no cases of severe anaemia after FCM administration, while 7.7% of patients were severely anaemic before FCM treatment. There were significant differences (p < 0.001) before and after correction of preoperative anaemia and/or iron deficiency with FCM in Hb, serum ferritin and transferrin saturation rate (TS). In the ABT group, there were significant differences between pre- and postoperative Hb levels (p < 0.001). Hb values tended to decrease, with 44.1% of patients moving from mild anaemia before transfusion to moderate anaemia in the postoperative period. Concerning the length of hospital stay, the group administered with ABTs had a longer hospital stay (p < 0.001). Regarding the clinical outcomes of nosocomial infection and mortality, there was no evidence that the rate of infection or mortality differed in each group (p = 0.075 and p = 0.243, respectively). However, there were fewer nosocomial infections in the FCM group (11.9% versus 21.2%) and mortality was higher in the transfusion group (21.2% versus 4.2%). Economic analysis showed that FCM could reduce allogenic blood products consumption and the associated costs. The economic impact of using FCM was around 19%. The preoperative Hb value improved when FMC was used. Patients who received ABTs appeared to have a longer hospital stay. The FCM group reported fewer infections during hospitalisation. The economic results showed savings of around €1000 for each patient with FCM administration. The use of FCM as part of the PBM program had a positive impact on patients' outcomes and on economic results. However, it will be essential to perform studies with a larger sample to obtain more robust and specific results.


Assuntos
Anemia Ferropriva , Anemia , Compostos Férricos , Maltose , Adulto , Humanos , Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/uso terapêutico , Hemoglobinas/uso terapêutico , Hospitais , Ferro/uso terapêutico , Maltose/uso terapêutico , Portugal , Estudos Retrospectivos , Medicina Estatal
6.
Artigo em Inglês | MEDLINE | ID: mdl-36360802

RESUMO

To investigate the association between gait speed (GS), cadence (CAD), gait stability ratio (GSR), and body balance (BB) with falls in a large sample of older adults. The analysis included 619 individuals-305 men and 314 women (69.50 ± 5.62 years)-residing in the Autonomous Region of Madeira, Portugal. Mobility in GS, CAD, and GSR was assessed using the 50-foot walk test and BB by the Fullerton Advanced Balance scale. The frequency of falls was obtained by self-report. Linear regression analysis showed that higher performance in GS and BB was able to reduce the risk of falling by up to 0.34 and 0.44 times, respectively. An increase in the GSR value enhanced the risk of falling by up to 0.10 times. Multinomial analysis indicated that, in relation to the highest tertile (reference), older adults classified with GS and BB performance in the lowest tertile (lowest) had an increased chance (OR) of falling by up to 149.3% and 48.8%, respectively. Moreover, in relation to the highest tertile, the performance of the GSR classified in the lowest and medium tercile showed an increase in the chance of falling by up to 57.4% and 56.4%, respectively.


Assuntos
Acidentes por Quedas , Velocidade de Caminhada , Masculino , Humanos , Feminino , Idoso , Acidentes por Quedas/prevenção & controle , Equilíbrio Postural , Marcha , Portugal
7.
Artigo em Inglês | MEDLINE | ID: mdl-36360810

RESUMO

Adolescents and young adults are an important target concerning reducing health-risk behavior adoption, including sexual health. Studying their knowledge concerning sexuality and their main counsellors, can be an important step in targeting an updated health promotion approach. This study characterized adolescents and young adults' knowledge and attitudes about sexually transmitted diseases (STDs), and contraception, prospecting for their main trusted counseling sources. We conducted a cross-sectional, population-based, self-report survey of 746 individuals aged between 14 and 24 years from Paredes, Portugal. The questionnaire included many dimensions, as demographic characteristics, youth behavior, currently sexually active status, main counselors concerning health topics, awareness, and knowledge about STDs and contraception. Mean age of the participants was 18.3 years, 50.5% of them had started their sexual activity. Males present themselves as more sexually active, starting earlier, and have more sexual partners than females. Participants reported an adequate knowledge perception about STDs and contraception methods, however we found different patterns on specific STDs and contraceptive methods, according to gender, age, and sexually active status. Our results help design specific interventions to reach youth, community, and healthcare providers, pointing out the value of bringing people to the center of health policies.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Infecções Sexualmente Transmissíveis , Adolescente , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Estudos Transversais , Portugal , Infecções Sexualmente Transmissíveis/prevenção & controle , Anticoncepção , Comportamento Sexual
8.
Artigo em Inglês | MEDLINE | ID: mdl-36361032

RESUMO

BACKGROUND: The nursing perspectives on suicidal behaviors may influence the quality of assistance and suicidal prevention. This phenomenon is scarcely investigated among nursing students. AIMS: The aim of this study is to understand the meanings of suicidal behavior for Portuguese undergraduate students. METHODS: This qualitative study utilized Grounded Theory and Symbolic Interactionism. We collected data in Portugal in 2017-2018 with 13 undergraduate students. RESULTS: Students compared suicidal behavior to "A complex and close haze" and considered it "A neglected phenomenon". Suicidal behavior was predominantly perceived as an emotional distress that requires assistance. The students compared the person and society as "The car and the road: behavior influenced by communication and interaction" and valorized social dimensions and repercussions of suicidal behavior. LIMITATIONS: Lack of triangulation in the data and the sampling restricted to nursing students of a single institution are considered limitations of this study. CONCLUSIONS: This study can contribute to the development of academic education strategies and psychosocial support for nursing students.


Assuntos
Estudantes de Enfermagem , Suicídio , Humanos , Estudantes de Enfermagem/psicologia , Ideação Suicida , Portugal , Suicídio/prevenção & controle , Teoria Fundamentada
9.
Artigo em Inglês | MEDLINE | ID: mdl-36361111

RESUMO

During the COVID-19 pandemic, nurses were exposed to many stressors, which may have been associated with some mental health problems. However, most of the studies carried out on nurses' quality of life and workplace wellbeing during the COVID-19 pandemic took a pathogenic approach. Given that current scientific knowledge in this field presented too many gaps to properly inform preventive and therapeutic action, the aim of this study was to explore whether protective factors (resilience, perceived social support, and professional identification) and stressors (perceived stress and psychosocial risks in the workplace) influenced the quality of life and workplace wellbeing perceived by Portuguese nurses during the COVID-19 pandemic. Data for this cross-sectional study was collected through online self-administered questionnaires. Linear regression models were used to analyze the relationships between variables. Results showed that perceived stress, resilience and job satisfaction were associated with quality of life and workplace wellbeing among Portuguese nurses. The study's findings could serve to inform health policy and should draw the attention of nursing managers to the needs and difficulties reported by nurses, to the importance of providing them with emotional support, and to the relevance of promoting a good work environment.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Humanos , COVID-19/epidemiologia , Local de Trabalho/psicologia , Pandemias , Qualidade de Vida , Estudos Transversais , Fatores de Proteção , Portugal/epidemiologia , Satisfação no Emprego , Inquéritos e Questionários
10.
Artigo em Inglês | MEDLINE | ID: mdl-36361270

RESUMO

The pandemic of COVID-19 caused significant changes in economies and societies with a major impact on the entire education process. However, these changes did not invalidate a constant effort of adaptation. This cross-sectional, descriptive, and correlational study used an online questionnaire administered to students from various study cycles at higher education institutions in Portugal, with the aim of exploring the influence of literacy and mental health on the use of mental health promotion strategies during COVID-19 confinement. A total of 329 students from higher education institutions participated in this study, mostly from the age group 18-24 years (n = 272; 82.7%) and female (n = 265, 80.5%). The most mentioned health promotion strategies during this period included studying (n = 170; 51.7%); physical activities (n = 151, 45.9%); social networking (n = 124, 37.7%); cooking activities (n = 120, 36.5%); and listening to music (n = 118, 35.9%). Academic success is self-reported, and it is weakly correlated with the MHI5 (r = 0.103, p = 0.063). Students in the pre-graduate programs studied more during the times of the pandemic and used this activity as a mental-health-promoting strategy with a statistically significant difference (p = 0.033). Although it was difficult to improve health literacy related to COVID-19 in such a short period of time, there was a very strong motivation to access, understand, evaluate, communicate, synthesize, and apply information and knowledge to maintain mental health through self-care using health promotion strategies.


Assuntos
COVID-19 , Letramento em Saúde , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , COVID-19/epidemiologia , Pandemias , Saúde Mental , Portugal/epidemiologia , Estudos Transversais , Estudantes , Promoção da Saúde
11.
Artigo em Inglês | MEDLINE | ID: mdl-36361333

RESUMO

This study examines the possibility of correlation between the data on human mobility restrictions and the COVID-19 infection rates in two European countries: Poland and Portugal. The aim of this study is to verify the correlation and causation between mobility changes and the infection spread as well as to investigate the impact of the introduced restrictions on changes in human mobility. The data were obtained from Google Community Mobility Reports, Apple Mobility Trends Reports, and The Humanitarian Data Exchange along with other reports published online. All the data were organized in one dataset, and three groups of variables were distinguished: restrictions, mobility, and intensity of the disease. The causal-comparative research design method is used for this study. The results show that in both countries the state restrictions reduced human mobility, with the strongest impact in places related to retail and recreation, grocery, pharmacy, and transit stations. At the same time, the data show that the increase in restrictions had strong positive correlation with stays in residential places both in Poland and Portugal.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Portugal/epidemiologia , Polônia/epidemiologia , SARS-CoV-2 , Europa (Continente)
12.
BMC Psychiatry ; 22(1): 713, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384505

RESUMO

BACKGROUND: Mental Health Literacy (MHL) has become a focus of research in recent decades, as a prerequisite for early identification and intervention for mental health problems. Although several instruments have been developed for assessing MHL, there is a need for brief and psychometrically sound measures to capture important aspects of MHL in large and diverse adult samples. The present study aimed to: (1) provide a revised and shorter version of a previously validated questionnaire for assessing MHL; and (2) examine the psychometric properties of the MHLq-SVa in student samples from six different countries (China, India, Indonesia, Portugal, Thailand, and United States). METHODS: The study involved 2180 senior school and undergraduate students, aged between 17 and 25 years old, from China, India, Indonesia, Portugal, Thailand, and the United States. Participants responded to the Mental Health Literacy Questionnaire for young adults (MHLq-ya), in their native language, following its translation and adaptation for each culture. The MHLq-ya comprises 29 items, organized into four dimensions: Knowledge of mental health problems; Erroneous beliefs/stereotypes; First-aid skills and help-seeking behavior; Self-help strategies. Confirmatory factor analyses and internal consistency analyses were performed on the combined data. RESULTS: Data from the different countries supported a shorter version of the questionnaire (MHLq-SVa), composed of 16 items that fit with previously defined dimensions. Internal consistency and between-factor correlations further supported the adequacy of the instrument's psychometric properties. CONCLUSION: The study provided preliminary support for the construct validity and reliability of the MHLq-SVa as a measure for assessing MHL in young adults from six different countries and languages. Future studies are needed to further validate the measure and undertake multicultural comparisons of MHL in diverse samples from around the globe.


Assuntos
Letramento em Saúde , Adulto Jovem , Humanos , Estados Unidos , Adolescente , Adulto , Letramento em Saúde/métodos , Saúde Mental , Reprodutibilidade dos Testes , Indonésia , Portugal , Tailândia , Inquéritos e Questionários , China
13.
Front Public Health ; 10: 986158, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388292

RESUMO

Introduction: Physical activity is essential for a healthy life and quality of life, representing a fundamental role in individuals' physical and mental health. Concomitantly, the physical therapist, through the promotion of physical activity and exercise, can improve mental health, an essential factor in the current pandemic, triggering anxiety, fear, and depression crisis. Objective: To verify physical activity among Portuguese physical therapists and its association with mental health during pandemic times. Methods: An online questionnaire was applied through social media to all Portuguese physical therapists between October 21, 2021, and January 14, 2022. It contained general characterization questions of the sample, the IPAQ-SF questionnaire to assess physical activity levels, the Goldberg General Health Questionnaire (GHQ-28), which assesses the levels of mental health and the WHO Well-Being Index (WHO-5) to assess the subjective wellbeing. Results: The sample totaled 286 respondents (82% female), with a mean age of 33. Of the total answers, 82% practiced physical activity, 45% had moderate levels of physical activity, and 19% vigorous. Physical therapists in these categories had lower values in the GHQ-28 and higher in the WHO-5. Those with better mental health also showed better subjective wellbeing (r = -0.571, p = 0.000). Conclusion: The data obtained showed that physical therapists mostly have moderate and vigorous levels of physical activity and that physical activity positively influences individuals' mental health and wellbeing, which proved to be a key factor due to the pandemic situation.


Assuntos
COVID-19 , Fisioterapeutas , Humanos , Feminino , Adulto , Masculino , Saúde Mental , COVID-19/epidemiologia , Pandemias , Qualidade de Vida/psicologia , Portugal/epidemiologia , Exercício Físico
14.
Vaccine ; 40(49): 7115-7121, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36404429

RESUMO

Vaccination strategies to control COVID-19 have been ongoing worldwide since the end of 2020. Understanding their possible effect is key to prevent future disease spread. Using a modelling approach, this study intends to measure the impact of the COVID-19 Portuguese vaccination strategy on the effective reproduction number and explore three scenarios for vaccine effectiveness waning. Namely, the no-immunity-loss, 1-year and 3-years of immunity duration scenarios. We adapted an age-structured SEIR deterministic model and used Portuguese hospitalisation data for the model calibration. Results show that, although the Portuguese vaccination plan had a substantial impact in reducing overall transmission, it might not be sufficient to control disease spread. A significant vaccination coverage of those above 5 years old, a vaccine effectiveness against disease of at least 80% and softer non-pharmaceutical interventions (NPIs), such as mask usage and social distancing, would be necessary to control disease spread in the worst scenario considered. The immunity duration scenario of 1-year displays a resurgence of COVID-19 hospitalisations by the end of 2021, the same is observed in 3-year scenario although with a lower magnitude. The no-immunity-loss scenario presents a low increase in hospitalisations. In both the 1-year and 3-year scenarios, a vaccination boost of those above 65 years old would result in a 53% and 38% peak reduction of non-ICU hospitalisations, respectively. These results suggest that NPIs should not be fully phased-out but instead be combined with a fast booster vaccination strategy to reduce healthcare burden.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Pré-Escolar , Idoso , Portugal/epidemiologia , COVID-19/prevenção & controle , Vacinação , Cobertura Vacinal
15.
BMJ Case Rep ; 15(11)2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36379630

RESUMO

Familial amyloidosis of the Finnish type (FAF) is a rare multisystemic disorder caused by mutations in the gelsolin gene. The clinical presentation is typically characterised by a triad of ophthalmic, neurological and dermatological findings. FAF has been reported in several countries, primarily in Finland and recently in Portugal. We report the first genetically confirmed cases of FAF from two unrelated families in our neuromuscular outpatient clinic. Gelsolin gene sequencing revealed the heterozygous gelsolin mutation (c.640G>A). The clinical features and the neurophysiological studies of two index patients and their relatives are presented. Obtaining an early diagnosis can be challenging, but FAF should be considered in the differential diagnosis of progressive bilateral facial neuropathy, even if there is no known Finnish ancestor.


Assuntos
Amiloidose Familiar , Gelsolina , Humanos , Gelsolina/genética , Finlândia , Amiloidose Familiar/diagnóstico , Amiloidose Familiar/genética , Mutação , Portugal
16.
Euro Surveill ; 27(44)2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36330821

RESUMO

BackgroundThe emergence of colistin resistance is a One Health antimicrobial resistance challenge worldwide. The close contact between companion animals and humans creates opportunities for transmission and dissemination of colistin-resistant bacteria.AimTo detect potential animal reservoirs of colistin-resistant Escherichia coli and investigate the possible sharing of these bacteria between dogs, cats and their cohabiting humans in the community in Lisbon, Portugal.MethodsA prospective longitudinal study was performed from 2018 to 2020. Faecal samples from dogs and cats either healthy or diagnosed with a skin and soft tissue or urinary tract infection, and their cohabiting humans were screened for the presence of colistin-resistant E. coli. All isolates were tested by broth microdilution against colistin and 12 other antimicrobials. Colistin-resistant isolates were screened for 30 resistance genes, including plasmid-mediated colistin resistance genes (mcr-1 to mcr-9), and typed by multilocus sequence typing. Genetic relatedness between animal and human isolates was analysed by whole genome sequencing.ResultsColistin-resistant E. coli strains harbouring the mcr-1 gene were recovered from faecal samples of companion animals (8/102; 7.8%) and humans (4/125; 3.2%). No difference between control and infection group was detected. Indistinguishable multidrug-resistant E. coli ST744 strains harbouring the mcr-1 gene were found in humans and their dogs in two households.ConclusionsThe identification of identical E. coli strains containing the plasmid-mediated mcr-1 gene in companion animals and humans in daily close contact is of concern. These results demonstrate the importance of the animal-human unit as possible disseminators of clinically important resistance genes in the community setting.


Assuntos
Infecções por Escherichia coli , Proteínas de Escherichia coli , Animais , Gatos/microbiologia , Cães/microbiologia , Humanos , Antibacterianos/farmacologia , Colistina/farmacologia , Farmacorresistência Bacteriana/genética , Escherichia coli , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/veterinária , Infecções por Escherichia coli/microbiologia , Proteínas de Escherichia coli/genética , Estudos Longitudinais , Testes de Sensibilidade Microbiana , Plasmídeos/genética , Portugal/epidemiologia , Estudos Prospectivos
17.
Rev. bioét. derecho ; 56: 55-74, Nov. 2022.
Artigo em Inglês | IBECS | ID: ibc-210237

RESUMO

Gestational surrogacy is a controversial ethical issue worldwide. In 2016, Portugal launched a second political attempt to legalize gestational surrogacy, proposing it as: being altruistic; forbidding a biological tie between the surrogate and the child; requiring a biological relationship between one of the legal parents and the child; and demanding a legal contract between the surrogate and the legal parents. The law was approved, regulatedand entered into force. However, months later, the Constitutional Court ruled some of its norms unconstitutional, namely due tothe legal ambiguity of the surrogacy contracts; too short a deadline for the surrogate’s withdraw of consent; and the need to comply with the children’s right to know their biological origin. The law entered a complex political and legal process. It also caused a serious problem in assisted reproductive treatments, with the suspension of those treatments that entailed the anonymity of the donors. The law on surrogacy was, finally, enacted in November 2021, although the introduction of its regulation is still pending.This paper describes the legal process, within its political context, stressing the ethical issues at stake, and presenting the initiative for legalization of gestational surrogacy in Portugal as a valuable case study analysis: of how a top-down initiative, ideologically driven and politically rushed, and which ignores ethical advice, generates a troubled and penalizinglegal process for the people involved.(AU)


La gestació subrogada és una qüestió ètica controvertida a tot el món. En 2016, Portugal va llançar un segon intent polític per a legalitzar la subrogació gestacional, proposant-la com: altruista; prohibint un vincle biològic entre la subrogada i el nen; exigint una relació biològica entre un dels pares legals i el nen; i exigint un contracte legal entre la subrogada i els pares legals. La llei va ser aprovada, reglamentada i va entrar en vigor. No obstant, mesos després, el Tribunal Constitucional va dictaminar la inconstitucionalitat d'algunes de les seves normes, en concret: l'ambigüitat jurídica dels contractes de gestació subrogada; un termini massa curt per a la retirada del consentiment de la mare de lloguer; i la necessitat de complir amb el dret dels nens a conèixer el seu origen biològic. La llei va entrar en un complex procés polític i jurídic. També va provocar un greu problema en els tractaments de reproducció assistida, amb la suspensió d'aquells que implicaven l'anonimat de les donants. La llei de gestació subrogada va ser, finalment, promulgada al novembre de 2021, si bé encara està pendent la introducció del seu reglament. Aquest treball descriu el procés legal, dins del seu context polític, posant l'accent en les qüestions ètiques en joc, i presentant aquesta iniciativa com una valuosa anàlisi de cas: de com una iniciativa de dalt a baix, ideològicament impulsada i políticament precipitada, i que ignora l'assessorament ètic, genera un procés legal problemàtic i penalitzador per a les persones implicades.(AU)


La gestación subrogada es una cuestión ética controvertida en todo el mundo. En 2016, Portugal lanzó un segundo intento político para legalizar la subrogación gestacional, proponiéndola como: altruista; prohibiendo un vínculo biológico entre la subrogada y el niño; exigiendo una relación biológica entre uno de los padres legales y el niño; y exigiendo un contrato legal entre la subrogada y los padres legales. La ley fue aprobada, reglamentada y entró en vigor. Sin embargo, meses después, el Tribunal Constitucional dictaminó la inconstitucionalidad de algunas de sus normas, en concreto: la ambigüedad jurídica de los contratos de gestación subrogada; un plazo demasiado corto para la retirada del consentimiento de la madre de alquiler; y la necesidad de cumplir con el derecho de los niños a conocer su origen biológico. La ley entró en un complejo proceso político y jurídico. También provocó un grave problema en los tratamientos de reproducción asistida, con la suspensión de aquellos que implicaban el anonimato de las donantes. La ley de gestación subrogada fue, finalmente, promulgada en noviembre de 2021, aunque aún está pendiente la introducción de su reglamento. Este trabajo describe el proceso legal, dentro de su contexto político, haciendo hincapié en las cuestiones éticas que están en juego, y presentando la iniciativa de legalización de la gestación subrogada en Portugal como un valioso análisis de caso: de cómo una iniciativa de arriba abajo, ideológicamente impulsada y políticamente precipitada, y que ignora el asesoramiento ético, genera un proceso legal problemático y penalizador para las personas implicadas.(AU)


Assuntos
Humanos , Gravidez , Mães Substitutas , Política de Saúde , Técnicas Reprodutivas , Consentimento Livre e Esclarecido , Direitos Sexuais e Reprodutivos , Poder Familiar , Jurisprudência , Portugal , Bioética , Ética , Direitos Humanos , Princípios Morais
18.
Sci Rep ; 12(1): 17936, 2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36289261

RESUMO

The U-series dating of young and 'dirty' speleothems is challenging due to difficulties in assessing the isotopic composition of detrital contaminants and the low-abundance of 230Th generated in situ. Here we propose a new dating approach based on the comparison of a speleothem's paleomagnetic directions to reference curves from global paleomagnetic reconstructions. This approach is demonstrated on a stalagmite collected from the Soprador do Carvalho cave in the Central Region of Portugal. A radioisotopic age model, built using four U-series ages and three 14C, suggests relatively steady carbonate precipitation from ~ 5760 BCE until ~ 1920 CE. Forty-five 6 mm-thick subsamples were analyzed using alternating field and thermal demagnetization protocols, providing well-defined, primary magnetic directions. An age model of the stalagmite was obtained by fitting its paleomagnetic record with the reference paleosecular variation curves obtained by previous paleo-reconstruction models, applying statistical bootstrapping analysis to define their best fit. The resulting age models fit closely with the radioisotopic age model but provide a significantly higher time resolution. We reach the same conclusion when applying this approach to another stalagmite from the Algarve region of Portugal. Our approach thus appears a promising alternative to date young speleothems with high detrital contents.


Assuntos
Carbonatos , Magnetismo , Portugal
19.
BMJ Open ; 12(10): e061919, 2022 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-36283755

RESUMO

PURPOSE: The CRIAS (Health trajectories of Immigrant Children in Amadora) cohort study was created to explore whether children exposed to a migratory process experience different health risks over time, including physical health, cognitive, socioemotional and behavioural challenges and different healthcare utilisation patterns. PARTICIPANTS: The original CRIAS was set up to include 604 children born in 2015, of whom 50% were immigrants, and their parents. Recruitment of 420 children took place between June 2019 and March 2020 at age 4/5 years, with follow-up carried out at age 5/6 years, at age 6/7 years currently under way. FINDINGS TO DATE: Baseline data at age 4/5 years (2019-2020) suggested immigrant children to be more likely to belong to families with less income, compared with non-immigrant children. Being a first-generation immigrant child increased the odds of emotional and behavioural difficulties (adjusted OR 2.2; 95% CI: 1.06 to 4.76); more immigrant children required monitoring of items in the psychomotor development test (38.5% vs 28.3%). The prevalence of primary care utilisation was slightly higher among immigrant children (78.0% vs 73.8%), yet they received less health monitoring assessments for age 4 years. Utilisation of the hospital emergency department was higher among immigrants (53.2% vs 40.6%). Age 5 years follow-up (2020-2021) confirmed more immigrant children requiring monitoring of psychomotor development, compared with non-immigrant children (33.9% vs 21.6%). Economic inequalities exacerbated by post-COVID-19 pandemic confinement with parents of immigrant children 3.2 times more likely to have their household income decreased. FUTURE PLANS: Further follow-up will take place at 8, 10, 12/13 and 15 years of age. Funds awarded by the National Science Foundation will allow 900 more children from four other Lisbon area municipalities to be included in the cohort (cohort-sequential design).


Assuntos
COVID-19 , Camelídeos Americanos , Emigrantes e Imigrantes , Criança , Humanos , Animais , Pré-Escolar , Estudos de Coortes , Estudos Prospectivos , Portugal/epidemiologia , Pandemias , COVID-19/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-36293975

RESUMO

The Portuguese health system has a universal, public, general National Health Service (NHS), tending towards free healthcare access. Created in 1979, this delivery model developed from the integration and complementarity between the different response levels (primary, hospital, continuing, and palliative care). However, over the last 40 years, the initially centralized system underwent a decentralization process with the creation of Regional Health Administrations in the five mainland administrative regions. Since then, the entire NHS has settled around this new organization. The most recent step started in 2018 with the decentralization of primary healthcare skills to 190 municipalities. This paper presents the various critical issues involved in the latest gradual decentralization process in health, intending to bring services closer to the citizens, and to be more focused on their needs. The article identifies and discusses the implications of this experience based on the steps foreseen in the already-published legal texts.


Assuntos
Acesso aos Serviços de Saúde , Medicina Estatal , Humanos , Portugal
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