Browsing by Author "Costa, E"
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- [ARIA 2019: An Integrated Care Pathway for Allergic Rhinitis in Portugal]Publication . Fonseca, J; Taveira-Gomes, T; Pereira, AM; Branco-Ferreira, M; Carreiro-Martins, P; Alves-Correia, M; Correia de Sousa, J; Costa, E; Lourenço, O; Morais-Almeida, M; Morête, A; Regateiro, F; Todo Bom, A; Bachert, C; Pfaar, O; Wallace, D; Bedbrook, A; Czarlewski, W; Bousquet, JThe Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative started more than 20 years ago and has developed and disseminated evidence-based guidelines and projects in the field of allergic rhinitis. This initiative is currently focused on providing patient-centred guidelines that contribute to an integrated care pathway between the various levels of care and take advantage of digital solutions, and the introduction of integrated care pathways in clinical practice has been recommended. In this article we describe the adaptation for Portugal of the ARIA Integrated Care Pathways document. After a brief review of the epidemiology and impact of allergic rhinitis in Portugal and the activities carried out in Portugal within the ARIA initiative, we describe the broad knowledge base used for the development of recommendations for the pharmacological treatment of allergic rhinitis, and these recommendations are based on the GRADE methodology, real world evidence acquired by mobile technology (mHealth) and resulting from allergenic exposure chamber studies. What follows is a summary of integrated care pathways for allergen immunotherapy produced in 2019. Allergen immunotherapy is considered an example of precision medicine where the use of mHealth technologies will improve stratification for patient selection and response monitoring. These recommendations were considered as best practices of integrated patient-centred care supported by digital systems from Directorate General for Health and Food Safety of the European Union (DG Santé) and represent the ARIA Phase 4 Change Management strategy.
- Body Fat Percentage Is a Major Determinant of Total Bilirubin Independently of UGT1A1*28 Polymorphism in Young ObesePublication . Belo, L; Nascimento, H; Kohlova, M; Bronze-da-Rocha, E; Fernandes, J; Costa, E; Catarino, C; Aires, L; Mansilha, HF; Rocha-Pereira, P; Quintanilha, A; Rêgo, C; Santos-Silva, AOBJECTIVES: Bilirubin has potential antioxidant and anti-inflammatory properties. The UGT1A1*28 polymorphism (TA repeats in the promoter region) is a major determinant of bilirubin levels and recent evidence suggests that raised adiposity may also be a contributing factor. We aimed to study the interaction between UGT1A1 polymorphism, hematological and anthropometric variables with total bilirubin levels in young individuals. METHODS: 350 obese (mean age of 11.6 years; 52% females) and 79 controls (mean age of 10.5 years; 59% females) were included. Total bilirubin and C-reactive protein (CRP) plasma levels, hemogram, anthropometric data and UGT1A1 polymorphism were determined. In a subgroup of 74 obese and 40 controls body composition was analyzed by dual-energy X-ray absorptiometry. RESULTS: The UGT1A1 genotype frequencies were 49.9%, 42.7% and 7.5% for 6/6, 6/7 and 7/7 genotypes, respectively. Patients with 7/7 genotype presented the highest total bilirubin levels, followed by 6/7 and 6/6 genotypes. Compared to controls, obese patients presented higher erythrocyte count, hematocrit, hemoglobin and CRP levels, but no differences in bilirubin or in UGT1A1 genotype distribution. Body fat percentage was inversely correlated with bilirubin in obese patients but not in controls. This inverse association was observed either in 6/7 or 6/6 genotype obese patients. UGT1A1 polymorphism and body fat percentage were the main factors affecting bilirubin levels within obese patients (linear regression analysis). CONCLUSION: In obese children and adolescents, body fat composition and UGT1A1 polymorphism are independent determinants of total bilirubin levels. Obese individuals with 6/6 UGT1A1 genotype and higher body fat mass may benefit from a closer clinical follow-up.
- Nutrition Day in nursing homes – risk factors for malnutritionPublication . Marques, M; Damas, M; Costa, E; Brás, M; Lemos, A; Costa, V; Faria, AnaIntroduction: Malnutrition in institutionalized older adults has a significant prevalence, and is associated with cognitive decline, higher morbidity and mortality rates. Objectives: The aim of this study was to assess risk factors for malnutrition in nursing home residents. Methods: Through Nutrition Day audit (2016–2018), demographic and anthropometric data was collected, as well as medical history and nutritional status according to Mini Nutritional Assessment. Results: Sixty-three individuals were included (57.1% male), with a mean age of 849 years. Mean Body Mass Index was 21.55.1 kg/m2. Malnutrition was identified in 47.6% of the patients and nutritional risk in 28.6%. Most of the sample (61.9%) was bedridden or in wheelchair. Most of the individuals showed dementia (82.5%) and depression (79.3%). A positive moderate significant correlation was found between nutritional status and cognitive status (r = 0.407;p=0.001); and between nutritional status and functional capacity (r = 0.474;p=0.000). Considering the diagnosis which caused institutionalization, brain pathologies were the most prevalent (79.4%), followed by cardiovascular diseases (49.2%) and skeletal muscle diseases (27.0%). Mean number of medications taken daily was 74 and 74.6% of the residents were polymedicated. The majority (61.9%) was taking antipsychotics and/or neuroleptics and 28.6% were taking antidepressives. Conclusions: In this sample, individuals are essentially older adults with a high prevalence of malnutrition. The high level of dependence and the presence of dementia are significant risk factors for the development of this condition. Disturbed emotional status and the use of multiple drugs associated with impaired appetite, although without statistically significant associations with nutritional status, are highly prevalent in this sample. Nutritional screening in this population is essential and timely necessary, aiming to prevent deterioration or improve nutritional status.
- Strategies to Reduce the Burden of Respiratory Syncytial Virus Infections in Children in Portugal: Results from the Focus Group RSV Think TankPublication . Ferreira-Magalhães, M; Bandeira, T; Costa, E; Guerra, P; Lopes, H; Martins, MR; Mexia, R; Tomé, T; Silva, E; Dias, AR