Browsing by Author "Silva, C"
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- Análise económica do rituximab, em associação com ciclofosfamida, vincristina e prednisolona no tratamento de doentes com linfoma folicular avançado em PortugalPublication . Braga, P; Carvalho, S; Gomes, M; Guerra, L; Lúcio, P; Marques, H; Negreiro, F; Pereira, C; Silva, C; Teixeira, AOBJECTIVE: Evaluate costs and benefits of rituximab in combination with cyclophosphamide/vincristine/prednisolone chemotherapy regimen (R-CVP), in previously untreated patients with indolent non-Hodgkin lymphoma (NHL), compared to CVP alone from a Portuguese National Health System (NHS) perspective. METHODS: Cost-effectiveness (Life Years Gained--LYG) and cost-utility analysis (Quality Adjusted Life Years--QALYs) were performed for a time horizon of 10 years, according to a Markov economic model with three health states (progression free survival, progression and death) and monthly cycles for a population of previously untreated patients with indolent NHL. Data from a phase III clinical trial was used and expanded to include unpublished 53-month median follow-up data. Survival after first-line therapy was estimated from the Scotland and Newcastle Lymphoma Group registry data and utilities were derived from a study in the UK performed in patients with follicular lymphoma. Resource consumption was estimated by a Portuguese expert panel (Delbecq Panel). Costs were calculated from the Portuguese NHS perspective through official data with prices updated to 2008. Only direct medical costs were considered. Costs and clinical outcomes were discounted at 5% per annum. Deterministic and probabilistic sensitivity analysis were performed around assumptions on the time horizon, costs, utilities and excess mortality rate due to progression applied in the base-case analysis. RESULTS: The 10-year base-case analysis showed a lower total cost per patient with CVP alone (€ 85,838) in comparison with R-CVP (€ 87,774). Life expectancy and Quality adjusted life expectancy per patient were higher with R-CVP (6.361 and 4.166, respectively) than with CVP alone (5.557 and 3.438, respectively), representing increases of 0.804 in LYG and 0.728 (8.7 months) in QALYs gained. The incremental cost per LYG was € 2,407 and the incremental cost per QALY gained was € 2,661. The probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results. CONCLUSIONS: This study demonstrates that the combination R-CVP in previously untreated indolent NHL patients improves life expectancy and is a cost-effective alternative to CVP in Portugal.
- Effectiveness of the flipped classroom methodology In the performance of higher education students: systematic review with meta-analysisPublication . Santos, Hugo; Santos, A; Rodrigues, C; Valeriano, J; Lopes, L; Freitas, M J; Esteves, R; Silva, CIntroduction: The methodology Flipped Classroom (FC) consists in individual activities that the student has to do at home through the use of technologies which help the student to prepare for class, and during classes, activities are performed as more dynamic classes centered on the student. Through the years, the success has reached the maximum levels of performance and satisfaction in the teaching sessions in different areas of education compared to the classical methods, and there are no conclusive and considerable studies that compile and analyze this information succinctly. Objective: To analyze experimental and quasi-experimental studies that evaluate the methodology database in FC in performance and student satisfaction in comparison with the expository methodology. Methodology: This article is a systematic review that analyzes the randomized controlled trial (RCT) and Quasi-experimental studies selected with the methodology FC, which measures the efficacy through the results achieved in the realization and evaluation of the students. These articles were found in EBSCOhost and PubMed. Results: We selected 41 articles, that fulfilled all inclusion criteria established by the authors, for the accomplishment of this systematic review. Discussion: The results of our meta-analysis, both RCTs and quasi-experimental studies, point to a better effectiveness of the FC methodology compared to the expository methodology in academic performance. However, there is a heterogeneity in planned and developed activities during class, which means that our conclusions can’t be generalized. The poor methodological quality of the included studies, especially quasi-experimental studies, does not allow our conclusions about efficacy to be vigorous. Nevertheless, based on these first promising data, it seems to us that this methodology offers learning opportunities that aren’t possible in a classroom based on lectures and subject matter exposition. Conclusion: Although the articles selected have poor methodological quality, and it is necessary more rigorous investigations on this methodology, we believe that the FC methodology could revolutionize teaching methods and replace traditional teaching, which is so deeply rooted in today's society and doesn’t seems to favor the achievement of transversal competences.
- Effectiveness of the flipped classroom methodology in the performance of higher educationh students: systematic review with meta-analysisPublication . Santos, Hugo; Santos, A; Rodrigues, C; Valeriano, J; Lopes, L; Freitas, M J; Esteves, R; Silva, Cntroduction: The methodology Flipped Classroom (FC) consists in individual activities that the student has to do at home through the use of technologies which help the student to prepare for class, and during classes, activities are performed as more dynamic classes centered on the student. Through the years, the success has reached the maximum levels of performance and satisfaction in the teaching sessions in different areas of education compared to the classical methods, and there are no conclusive and considerable studies that compile and analyze this information succinctly. Objective: To analyze experimental and quasi-experimental studies that evaluate the methodology database in FC in performance and student satisfaction in comparison with the expository methodology. Methodology: This article is a systematic review that analyzes the RCT and Quasi - experimental studies selected with the methodology FC, which measures the efficacy through the results achieved in the realization and evaluation of the students. These articles were found in EBSCOhost and PubMed. Results: We selected 41 articles, that fulfilled all inclusion criteria established by the authors, for the accomplishment of this systematic review. The results of our meta-analysis, both RCTs and quasi experimental studies, point to a better effectiveness of the FC methodology compared to the expository methodology in academic performance. However, there is a heterogeneity in planned and developed activities during class, which means that our conclusions can’t be generalized. The poor methodological quality of the included studies, especially quasi-experimental studies, does not allow our conclusions about efficacy to be vigorous. Nevertheless, based on these first promising data, it seems to us that this methodology offers learning opportunities that aren’t possible in a classroom based on lectures and subject matter exposition. Conclusion: Although the articles selected have poor methodological quality, and is necessary more rigorous investigations on this methodology, we believe that the FC methodology could revolutionize teaching methods and replace traditional teaching, which is so deeply rooted in today's society and doesn’t seems to favor the achievement of transversal competences.
- Factors Associated With Clinical and Radiographic Severity in People With Osteoarthritis: A Cross-Sectional Population-Based StudyPublication . Costa, D; Cruz, EB; Silva, C; Canhão, H; Branco, J; Nunes, C; Rodrigues, AMBackground: Hip/knee osteoarthritis (HKOA) is a leading cause of disability and imposes a major socioeconomic burden. The aim of this study is to estimate the prevalence of HKOA in Portugal, characterised the clinical severity of HKOA in the population, and identified sociodemographic, lifestyle, and clinical factors associated with higher clinical and radiographic severity. Methods: Participants with a diagnosis of HKOA from the EpiReumaPt study (2011-2013) were included (n = 1,087). Hip/knee osteoarthritis diagnosis was made through a structured evaluation by rheumatologists according to American College of Rheumatology criteria. Clinical severity was classified based on Hip Disability and Osteoarthritis Outcome Scale (HOOS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) score tertiles. Radiographic severity was classified based on the Kellgren-Lawrence grades as mild, moderate, or severe. Sociodemographic lifestyle and clinical variables, including the presence of anxiety and depression symptoms, were analysed. Factors associated with higher clinical and radiographic severity were identified using ordinal logistic regression models. Results: Hip/knee osteoarthritis diagnosis was present in 14.1% of the Portuguese population [12.4% with knee osteoarthritis (OA) and 2.9% with hip OA]. Clinical severity was similar between people with hip (HOOS = 55.79 ± 20.88) and knee (KOOS = 55.33 ± 20.641) OA. People in the high HOOS/KOOS tertile tended to be older (64.39 ± 0.70 years), female (75.2%), overweight (39.0%) or obese (45.9%), and had multimorbidity (86.1%). Factors significantly associated with higher clinical severity tertile were age [55-64 years: odds ratio (OR) = 3.18; 65-74 years: OR = 3.25; ≥75 years: OR = 4.24], female sex (OR = 1.60), multimorbidity (OR = 1.75), being overweight (OR = 2.01) or obese (OR = 2.82), and having anxiety symptoms (OR = 1.83). Years of education was inversely associated with higher clinical severity. Factors significantly associated with higher radiographic severity were age (65-74 years: OR = 3.59; ≥75 years: OR = 3.05) and being in the high HOOS/KOOS tertile (OR = 4.91). Being a female and live in Lisbon or in the Centre region were inversely associated with the higher radiographic severity. Conclusion: Hip/knee osteoarthritis is present in ~1.1 million of Portuguese people. Age, educational level, and obesity are independently associated with HKOA clinical severity, whereas age, sex, geographic location, and clinical severity are independently associated with radiographic severity.
- A large outbreak of Legionnaires’ Disease in an industrial town in PortugalPublication . George, F; Shivaji, T; Pinto, CS; Serra, LA; Valente, J; Albuquerque, MJ; Vicêncio, PC; San-Bento, A; Diegues, P; Nogueira, PJ; Marques, T; Rebelo, H; Costa, F; Rodrigues, R; Nunes, A; Borges, V; Gomes, JP; Sampaio, D; Barreiro, P; Duarte, S; Carpinteiro, D; Mendonça, J; Silva, C; Vieira, L; Simões, MJ; Gonçalves, P; Nunes, B; Dias, C; Machado, J; Almeida, F; Goncalves, EA; Carvalho, L; Viterbo, P; Jardim, D; Lacasta, N; Boavida, F; Perez, A; Santana, I; Matias, P; Banza, N; Rabacal, CBackground We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak's attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.
- Physical activity levels in physiotherapy bachelor studentsPublication . Alves Lopes, António; Pires, J; Silva, CBackground: Physical activity is one of the best ways to promote health. University students are exposed to a series of obstacles to the practice of physical activity. Health professionals, more than prescribing physical exercise, and in particular physiotherapists, should be examples of healthy lifestyles and exercise practice, it is therefore important to have an estimate of the level of activity physical activity in students, in order to identify means of promoting it in Physiotherapy students. Objective: Describe the level of physical activity of students enrolled in the Physiotherapy Bachelor degree at the Escola Superior de Saúde do Alcoitão (ESSA) in the 4 years of the course. Methods: During 2018 the level of physical activity of 99 students was evaluated, using the short version of the International Questionnaire of Physical Activity (IPAQ), distributed to the students of the 4 years of the Physiotherapy Bachelor degree using an online survey. Results: In relation to the number of days of physical activity (59.8%) of the students answered that they practice physical activity every day of the week and only (4.1%) of the individuals answered that they do not practice any day, being that in men the level of moderate activity predominates, whereas in women there is a dispersion through the three levels of activity. The first year is what reveals a higher percentage in the activity level low (46.2%) and lower in the high activity level (38.5%) compared with other school years. Discussion: Based on the results obtained in this study, health professionals should note that the transition to higher education is a critical time to promote physical activity and implement new programs of physical activity mainly among women and in the first year of the course where to be observed a lower level of physical activity. Conclusion: In addition to having skills, for the prescription and monitoring of physical exercise, physiotherapists should be an example of a healthy lifestyle and regular practice of physical activity.
- Relationship between body mass index and mean arterial pressure in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study.Publication . Guedes-Martins, L; Carvalho, M; Silva, C; Cunha, A; Saraiva, J; Macedo, F; Almeida, H; Gaio, ARBACKGROUND: Being overweight is associated with both higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) during pregnancy and increased risk of gestational hypertensive disorders. The objective of this study was to determine and quantify the effect of body mass index (BMI) on mean arterial pressure (MAP) at several time points throughout pregnancy in normotensive (NT) and chronic hypertensive pregnant (HT) women. METHODS: A prospective longitudinal study was carried out in 461 singleton pregnancies (429 low-risk and 32 with chronic arterial hypertension), with measurements taken at the 1(st), 2(nd), and 3(rd) trimesters and at delivery. Linear mixed-effects regression models were used to evaluate the time-progression of BMI, SBP, DBP and MAP during pregnancy (NT vs. HT). The longitudinal effect of BMI on MAP, adjusted for the hypertensive status, was investigated by the same methodology. RESULTS: BMI consistently increased with time in both NT and HT women. In contrast, MAP decreased during the first half of pregnancy, after which it increased until the moment of delivery in both groups. A 5-unit increase in BMI was predicted to produce an increase of approximately 1 mmHg in population MAP values. This effect is independent from the time period and from hypertensive status. CONCLUSIONS: In both NT and HT pregnant women, MAP is strongly (and significantly) influenced by increases in BMI.
- Testicular epidermoid cyst: Ultrasound and MR typical findings with macroscopy correlationPublication . Pires-Gonçalves, L; Silva, C; Teixeira, M; Costa-Dias, S; Sousa-Mendes, V
- Testicular epidermoid cyst: Ultrasound and MR typical findings with macroscopy correlationPublication . Pires-Gonçalves, L; Silva, C; Teixeira, M; Costa-Dias, S; Sousa-Mendes, V