RCAAP Repository

Background & aims: No multi-national prospective study of drug-induced liver injury (DILI) has originated in Europe. The design of a prospective European DILI registry, clinical features and short-term outcomes of the cases and controls is reported. Methods: Patients with suspected DILI were prospectively enrolled in the United Kingdom, Spain, Germany, Switzerland, Portugal and Iceland, 2016-2021. DILI cases or non-DILI acute liver injury controls following causality assessment were enrolled. Results: Of 446 adjudicated patients, 246 DILI patients and 100 had acute liver injury due to other aetiologies, mostly autoimmune hepatitis (n = 42) and viral hepatitis (n = 34). DILI patients (mean age 56 years), 57% women, 60% with jaundice and 3.6% had pre-existing liver disease. DILI cases and non-DILI acute liver injury controls had similar demographics, clinical features and outcomes. A single agent was implicated in 199 (81%) DILI cases. Amoxicillin-clavulanate, flucloxacillin, atorvastatin, nivolumab/ipilimumab, infliximab and nitrofurantoin were the most commonly implicated drugs. Multiple conventional medications were implicated in 37 (15%) and 18 cases were caused by herbal and dietary supplements. The most common single causative drug classes were antibacterials (40%) and antineoplastic/immunomodulating agents (27%). Overall, 13 (5.3%) had drug-induced autoimmune-like hepatitis due to nitrofurantoin, methyldopa, infliximab, methylprednisolone and minocycline. Only six (2.4%) DILI patients died (50% had liver-related death), and another six received liver transplantation. Conclusions: In this first multi-national European prospective DILI Registry study, antibacterials were the most commonly implicated medications, whereas antineoplastic and immunomodulating agents accounted for higher proportion of DILI than previously described. This European initiative provides an important opportunity to advance the study on DILI.

A crise pandémica global afetou todos os setores da sociedade e o ensino superior não foi exceção. O objetivo central do presente estudo foi compreender a adaptação dos psicólogos de gabinetes de apoio psicológico ao trabalho em pandemia e os efeitos na carreira destas mudanças. O estudo exploratório utilizou uma entrevista semidiretiva a 12 psicólogos de gabinetes de apoio psicológico de universidades portuguesas como instrumento de recolha de dados. Esses dados foram estudados através de análise de conteúdo. Os resultados mostram que a adaptação foi mediada por barreiras e facilitadores, pessoais e contextuais, com peso no sucesso e noções de autoeficácia dos profissionais nos seus vários papéis de vida. Estes profissionais consideraram que o impacto na sua carreira se prende principalmente com o desenvolvimento de novas competências técnicas e pessoais e que a população das universidades sentiu os efeitos negativos da crise, o que se refletiu na maior procura de apoio psicológico, e no aumento quantitativo e agravamento de situações clínicas.

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Background: Small airways obstruction is a common feature of obstructive lung diseases. Research is scarce on small airways obstruction, its global prevalence, and risk factors. We aimed to estimate the prevalence of small airways obstruction, examine the associated risk factors, and compare the findings for two different spirometry parameters. Methods: The Burden of Obstructive Lung Disease study is a multinational cross-sectional study of 41 municipalities in 34 countries across all WHO regions. Adults aged 40 years or older who were not living in an institution were eligible to participate. To ensure a representative sample, participants were selected from a random sample of the population according to a predefined site-specific sampling strategy. We included participants' data in this study if they completed the core study questionnaire and had acceptable spirometry according to predefined quality criteria. We excluded participants with a contraindication for lung function testing. We defined small airways obstruction as either mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FEF25-75) less than the lower limit of normal or forced expiratory volume in 3 s to forced vital capacity ratio (FEV3/FVC ratio) less than the lower limit of normal. We estimated the prevalence of pre-bronchodilator (ie, before administration of 200 μg salbutamol) and post-bronchodilator (ie, after administration of 200 μg salbutamol) small airways obstruction for each site. To identify risk factors for small airways obstruction, we performed multivariable regression analyses within each site and pooled estimates using random-effects meta-analysis. Findings: 36 618 participants were recruited between Jan 2, 2003, and Dec 26, 2016. Data were collected from participants at recruitment. Of the recruited participants, 28 604 participants had acceptable spirometry and completed the core study questionnaire. Data were available for 26 443 participants for FEV3/FVC ratio and 25 961 participants for FEF25-75. Of the 26 443 participants included, 12 490 were men and 13 953 were women. Prevalence of pre-bronchodilator small airways obstruction ranged from 5% (34 of 624 participants) in Tartu, Estonia, to 34% (189 of 555 participants) in Mysore, India, for FEF25-75, and for FEV3/FVC ratio it ranged from 5% (31 of 684) in Riyadh, Saudi Arabia, to 31% (287 of 924) in Salzburg, Austria. Prevalence of post-bronchodilator small airways obstruction was universally lower. Risk factors significantly associated with FEV3/FVC ratio less than the lower limit of normal included increasing age, low BMI, active and passive smoking, low level of education, working in a dusty job for more than 10 years, previous tuberculosis, and family history of chronic obstructive pulmonary disease. Results were similar for FEF25-75, except for increasing age, which was associated with reduced odds of small airways obstruction. Interpretation: Despite the wide geographical variation, small airways obstruction is common and more prevalent than chronic airflow obstruction worldwide. Small airways obstruction shows the same risk factors as chronic airflow obstruction. However, further research is required to investigate whether small airways obstruction is also associated with respiratory symptoms and lung function decline.

O desenvolvimento da identidade vocacional e a planificação para o futuro são das tarefas de desenvolvimento mais importantes durante a adolescência. As experiências e contextos que cada um se encontra podem influenciar muitas das escolhas que são feitas ao longo da vida. Uma dessas influências pode surgir através da prática de desporto federado. O presente estudo teve como objetivo principal analisar a perspetiva temporal, planos para o futuro e satisfação com a vida em estudantes praticantes de desporto e estudantes não praticantes de desporto. Foram aplicados três instrumentos, o Inventário de Perspetiva Temporal, o questionário de Satisfação com a Vida e um questionário de Equilíbrio de Tarefas com dados importantes de cada participante e questões relacionadas com as suas tarefas e rotinas. Participaram no estudo 113 estudantes, que frequentam entre o 9º ano e 12º ano, com média de idades de 16.48 anos; 41.6% do sexo masculino e 58.4 % do sexo feminino. Quanto aos anos de escolaridade, participaram 10.6% de alunos do 9º ano, 30.1% do 10º ano, 23.9% do 11º ano e 35.4% do 12º ano de escolaridade. Esta amostra contém uma percentagem de 38.4% de praticantes de uma modalidade desportiva e 61.6 % de alunos que não praticam desporto. Os resultados deste estudo mostram que alunos que praticam desporto percecionam um maior equilíbrio de tarefas entre as diferentes atividades e maior motivação para a escola. Os praticantes de desporto apresentaram uma relação significativa entre a motivação para os estudos e os planos para o futuro. Conclui-se que os estudantes praticantes de desporto apresentam maior satisfação com a vida e são mais orientados para o presente.

Introduction: This study assessed the test-retest reliability/agreement and construct validity of the International Physical Activity Questionnaire short-form (IPAQ-sf) in patients with chronic obstructive pulmonary disease (COPD). It also explored differences in its validity according to age, sex and GOLD airflow obstruction levels. Methods: 62 participants (68 ± 8 years, 53 males, FEV1 51 ± 23%pred) completed the Portuguese IPAQ-sf, wore an accelerometer for 7 days and completed a second IPAQ-sf. Test-retest reliability/agreement was assessed with Intraclass Correlation Coefficient (ICC2,1), 95% Limits of Agreement (LoA), standard error of measurement (SEM) and minimal detectable change (MDC95) for continuous variables, and percentage of agreement (%agreement) for categories ("active"/"inactive"). Validity was assessed with 95% LoA and Spearman's correlations (ρ) between IPAQ-sf 2 (METs-min/week, time in vigorous [VPA], moderate PA [MPA] and walking) and accelerometry (time in MVPA, VPA, MPA and step counts) for continuous variables; %agreement, Cohen's kappa, and sensitivity specificity and±predictive values for categories. Correlations were also performed for age, sex and GOLD airflow obstruction grades. Results: Reliability was good (ICC2,1 = 0.707) with wide LoA (-6446-6409 METs-min/week). SEM and MDC95 were 1840 and 4971 METs-min/week, respectively. %agreement between the two IPAQ-sf was 84% (kappa = 0.660). Positive, moderate and significant correlations were found between IPAQ-sf and accelerometry (0.396 ≤ ρ ≤ 0.527, p < 0.001), except for VPA (p > 0.05). The strongest correlations were found in age (<65 years) and male (0.466 ≤ ρ ≤ 0.653, p < 0.05). %agreement between tools was 65% (kappa = 0.313), with high sensitivity (0.830) but low specificity (0.500). Conclusions: The IPAQ-sf seems valid to be used in COPD but caution on its widespread use is recommended as its accuracy may be limited.

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We surveyed changes to maternity care services in the first 17 months of the COVID-19 pandemic in 13 different European countries, from the perspective of national maternity service (parent) organizations advocating for a human rights approach to maternity services. A qualitative study was conducted in November 2020. An open-question survey was sent to national maternity service (parent) organizations and members of COST Action 18211 in Europe, asking about COVID-19 measures in maternity services (antenatally, intrapartum, postnatally, and overall satisfaction). From the open answers, 16 core issues were extracted. Between February and August 2021, semi-structured interviews with the national representatives of 14 parent member organizations in Europe were conducted, collecting details on overall national situations and changes due to COVID-19 measures. The reported experiences of parent organizations from 13 European countries show wide variations in epidemiological containment measures during the first 17 months of the COVID-19 pandemic. Practices differed between facilities, resulting in emotional disquiet and confusion for parent-patients. Most countries maintained antenatal and postnatal care but restricted psychosocial support (antenatal and birth companions, visitors). Organizations from nine countries reported that women had to wear masks during labor, and all but two countries saw separations of mothers and babies. Most parent organizations described a need for more reliable information for new parents. During the pandemic, non-evidence-based practices were (re-) established in many settings, depriving women and families of many factors which evidence has shown to be essential for a positive birthing experience. Based on the findings, we consider the challenges in maternity services and propose a strategy for future crises.

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Diabetes mellitus is a major chronic disease that continues to increase significantly. One of the most important and costly complications of diabetes is foot ulceration that may be colonized by pathogenic and antimicrobial resistant bacteria, which may express several virulence factors that could impair treatment success. These bacterial communities can be organized in polymicrobial biofilms, which may be responsible for diabetic foot ulcer (DFU) chronicity. We evaluated the influence of polymicrobial communities in the ability of DFU isolates to produce biofilm, using a microtiter plate assay and a multiplex fluorescent in situ hybridization, at three time points (24, 48, 72 h), after evaluating biofilm formation by 95 DFU isolates belonging to several bacterial genera (Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Acinetobacter). All isolates were biofilm-positive at 24 h, and the amount of biofilm produced increased with incubation time. Pseudomonas presented the higher biofilm production, followed by Corynebacterium, Acinetobacter, Staphylococcus and Enterococcus. Significant differences were found in biofilm formation between the three time points. Polymicrobial communities produced higher biofilm values than individual species. Pseudomonas + Enterococcus, Acinetobacter + Staphylococcus and Corynebacterium + Staphylococcus produced higher biofilm than the ones formed by E. faecalis + Staphylococcus and E. faecalis + Corynebacterium. Synergy between bacteria present in dual or multispecies biofilms has been described, and this work represents the first report on time course of biofilm formation by polymicrobial communities from DFUs including several species. The biological behavior of different bacterial species in polymicrobial biofilms has important clinical implications for the successful treatment of these infections.

De algumas décadas a esta parte, a relação entre visualidade e colonialismo tem conhecido crescente destaque no mapa das ciências sociais e humanas. Porém, no caso de Angola, enquanto o universo das imagens “fixas” tem sido alvo de um maior escrutínio, o arquivo das imagens “em movimento” permanece, largamente, por investigar. Ademais, e com a devida excepção assinalada para uma ou duas obras pioneiras, a crítica cinematográfica tem vindo a desenvolver pesquisas unilateralmente focadas no enquadramento colonial, entendendo-o, tout court, enquanto acção exercida pelo centro colonizador sobre a periferia colonizada. No encalço desta perspectiva redutora — que, herdeira de modos de saber eurocêntricos, ignora uma relação de forças que, embora assimétrica, sempre existiu —, a maioria dos estudos filmográficos tende a privilegiar a propaganda colonial do império português, arredando-se da análise dos documentos audiovisuais que, durante as guerras de libertação e aquando da independência, eram produzidos por angolanos e seus aliados. Sem rasurar as tecnologias visuais de inculcação ideológica fascista — que, ao longo do século XX e no substrato da Ditadura Militar e do Estado Novo se assumiram enquanto instrumentos centrais na (re)definição de identidades e narrativas individuais e colectivas no que concerne aos territórios ultramarinos e aos seus habitantes —, a presente dissertação propõe superar o papel marginal amiúde consignado à cinematografia anti- e pós-colonial, atentando no seu potencial emancipatório e recentrando o cinema enquanto espaço e locus epistemológico de resistência. Assim, e através de uma abordagem tripartida que atenta em cinquenta anos de produção documental sobre e de Angola, recortando e trazendo para primeiro plano o plateau da Huíla e as populações Ovamwila que nele habitam, averiguam-se dispositivos imagético-discursivos edificados pela potência colonial que sequestram ao Outro a sua imagem, mas também a potência do cinema enquanto linguagem capaz de restituir ao corpo colonizado a possibilidade de ser inteiro.

O presente estudo procurou explorar a relação entre as perturbações de personalidade e os traços de personalidade. Foram aplicados três instrumentos: um Questionário Sociodemográfico e as versões portuguesas da Escala do Nível de Funcionamento da Personalidade – Autorrelato (LPFS-SR) e do Inventário da Personalidade para o DSM-5 – Adultos (PID-5). Os resultados da LPFS-SR foram analisados comparando dois grupos de participantes de uma população clínica, um grupo de indivíduos com diagnóstico de perturbação da personalidade (n = 31) e um grupo de indivíduos com outros diagnósticos psiquiátricos (n = 109). Já para o PID-5 a amostra foi dividida em três grupos, um grupo de indivíduos com diagnóstico de perturbação de personalidade do Grupo B (n = 80), um grupo de indivíduos com diagnóstico de outras perturbações de personalidade (n = 43) e ainda um grupo de indivíduos com outros diagnósticos psiquiátricos (n = 336). Foi também analisada a capacidade preditiva dos domínios e do total da LPFS-SR relativamente ao diagnóstico de perturbações de personalidade. As hipóteses basearam-se na conceptualização teórica subjacente ao modelo alternativo da personalidade do DSM-5. Os resultados evidenciaram algumas diferenças significativas entre estes grupos em ambos os instrumentos. Sujeitos com perturbação de personalidade apresentam níveis mais elevados nos domínios Identidade, Autodireção, Intimidade e Total da LPFS-SR. Relativamente ao PID-5 verificou-se que o grupo de participantes com perturbação de personalidade do Grupo B obteve resultados significativamente superiores nos domínios Desinibição e Antagonismo e ainda nas facetas Hostilidade, Manipulação, Falsidade, Procura de Atenção, Impulsividade, Irresponsabilidade, Envolvimento em Comportamentos de Risco, Perseveração, Suspeição e Crenças e Experiências Incomuns. Por último, verificou-se também que a LPFS-SR não se mostra preditora das perturbações de personalidade, o que propomos ser explorado em estudos futuros.

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É comum o ser humano pertencer a várias categorias sociais, que por vezes contrastam entre si. Quando conciliamos esta informação contraditória, tendemos para o processamento mental na forma de raciocínio causal (Kunda et al., 1990; Hastie et al., 1990). Um sujeito que seja Padre e simultaneamente Segurança de discoteca, invoca traços que não pertencem a nenhuma das categorias, isoladamente, um traço emergente (Benrós et al., 2020). A estabilidade temporal de traços atribuídos a categorias compósitas carece de investigação, e é de sobeja importância neste contexto, dado que pode indicar que se originou a representação mental duma categoria nova. Neste estudo (N = 70), avalia-se a estabilidade temporal das representações mentais de categorias compósitas, entre indivíduos e intra-individual, através de uma tarefa de escolha/geração de traços, integrada numa metodologia teste-reteste. Manipulou-se também o processo de escolha dos traços, para cada estereótipo compósito. Num grupo os participantes geravam espontaneamente os traços, no outro, escolhiam os traços a partir de uma lista fornecida. A condição com ou sem lista, não teve um efeito no consenso entre indivíduos nem na estabilidade temporal obtida entre sessões, intra-individualmente. De modo geral, os traços emergentes foram considerados como mais centrais para o estereótipo compósito, os escolhidos de forma mais prevalente e que deram o maior contributo para a sua estabilidade temporal, seguido, imediatamente, dos estereótipos herdados (os quais não diferiram significativamente dos emergentes). A condição sem lista, que se esperava de maior dificuldade, e que, portanto, fomentasse o uso de raciocínio causal e de operações cognitivas mais complexas na geração dos emergentes, teve um efeito na produção de emergentes. Conforme a presença ou ausência de lista, viram-se diferentes padrões de resultados para os diferentes traços, com os traços averaged a aumentarem consideravelmente em proporção, centralidade e estabilidade, na condição sem lista. Discute-se o impacto dos resultados para a estabilidade temporal dos estereótipos compósitos e as suas implicações para a teorização sobre as representações destas categorias sociais.

This research intends to measure the quality of life (QoL) perception, from the perspective of residents and tourists towards Coimbra, a city with an important World Heritage Site, as classified by UNESCO. In these times, preserving tangible and intangible heritage is so important for future memories. Identifying the QoL perceptions through the eyes of residents and tourists allows the improvement of the community well-being of the destination for both stakeholders. Starting from this assumption, this study aims to: (i) measure the tourists’ and residents’ perceptions on quality of life (QoL); (ii) analyze the impact of the COVID-19 pandemic on QoL perceptions, both from the tourists’ and residents’ perspective. To achieve these objectives, a questionnaire was disseminated to residents and tourists in two different phases, before and during the COVID-19 pandemic. Results show that in general, residents and tourists exhibited, in both periods, medium and high perceptions of QoL, with an exception made for the Urban Issues domain that decreased even more during the pandemic. Furthermore, the results show, for residents and tourists, that the perception of Urban Issues, Way of Life, Community Pride and Awareness, Economic Strength, and Recreation Amenities impact significantly and positively their Community Well-Being perception. New paths for academics and for practitioners are presented at the end, as well as limitations and evidence for future research.

Introduction: Malaria in infants is common in high-transmission settings, especially in infants >6 months. Infants undergo physiological changes impacting pharmacokinetics and pharmacodynamics of anti-malarial drugs and, consequently, the safety and efficacy of malaria treatment. Yet, treatment guidelines and evidence on pharmacological interventions for malaria often fail to address this vulnerable age group. This review aims to summarize the available data on anti-malarial treatment in infants. Areas covered: The standard recommended treatments for severe and uncomplicated malaria are generally safe and effective in infants. However, infants have an increased risk of drug-related vomiting and have distinct pharmacokinetic parameters of antimalarials compared with older patients. These include larger volumes of distribution, higher clearance rates, and immature enzyme systems. Consequently, infants with malaria may be at increased risk of treatment failure and drug toxicity. Expert opinion: Knowledge expansion to optimize treatment can be achieved by including more infants in antimalarial drug trials and by reporting separately on treatment outcomes in infants. Additional evidence on the efficacy, safety, tolerability, acceptability, and effectiveness of ACTs in infants is needed, as well as population pharmacokinetics studies on antimalarials in the infant population.

Fluid therapy is an important supportive measure for patients with severe malaria. Patients with severe malaria usually have normal cardiac index, vascular resistance, and blood pressure and a small degree of hypovolaemia due to dehydration. Cell hypoxia, reduced kidney function, and acidosis result from microcirculatory compromise and malarial anaemia, which reduce tissue oxygenation, not hypovolaemia. Hence, aggressive fluid loading does not correct acid-base status, enhance kidney function, or improve patient outcomes, and it risks complications such as pulmonary oedema. Individualised conservative fluid management is recommended in patients with severe malaria. Physical examination and physiological indices have limited reliability in guiding fluid therapy. Invasive measures can be more accurate than physical examination and physiological indices but are often unavailable in endemic areas, and non-invasive measures, such as ultrasound, are mostly unexplored. Research into reliable methods applicable in low-resource settings to measure fluid status and response is a priority. In this Review, we outline the current knowledge on fluid management in severe malaria and highlight research needed to optimise fluid therapy and improve survival in severe malaria.

Community transmission of COVID-19 is ongoing in the majority of countries in sub-Saharan Africa (SSA), threatening, as elsewhere, the capacity of national healthcare systems (HCS) in low- and middle-income countries (LMIC). While the epidemic started slowly and late in SSA, currently - subject to often rapid changes - around 20,000 cases per day are reported, despite limited testing. Shortages of personal protective equipment (PPE), as well as sophisticated and expensive molecular diagnostic tests are of concern. However, the biggest worry is the lack of health care workers (HCW) and health care infrastructure as a few figures compellingly illustrate. SSA has only 0.2 physicians per 1000 inhabitants (Europe 3.7, North America 2.6), while 10,000 HCW across the continent were infected by the 23rd of July. In April, the WHO reported less than 2000 ventilators in 43, and only 5000 intensive care unit (ICU) beds in 41 African countries, respectively. Worst though, their distribution is highly skewed. While many countries in SSA having just a few, if any; in countries which govern such resources, like South Africa, they are mainly located in the private sector, creating corresponding access problems. Non-profit organisations help with the procurement of materials at lower prices, like the African Medical Supply Platform; yet, a single N95 mask still costs 2 USD a piece on this platform.

Since 1976, in more than 40 recorded outbreaks to date, Ebola virus disease (EVD) has dramatically affected the human population across the Central African region and adjacent areas. The large West African outbreak (2013–2015) was a game changer in many aspects, not only with regard to geographical location and the number of patients and deaths, but also in terms of the international community's response it finally triggered; albeit belatedly so. The progress made in our epidemiological and clinical understanding of the disease was immense, as well as advances in the development of an effective vaccine (e.g. rVZVZEBOV), specific therapeutic options (e.g. monoclonal antibodies, convalescent whole blood), and candidates for post-exposure prophylaxis (e.g. Favipiravir).

No summary/description provided