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- The 2018 periodontitis case definition improves accuracy performance of full-mouth partial diagnostic protocolsPublication . Botelho, João; Machado, Vanessa; Proença, Luís; Mendes, José JoãoWe aimed to compare the accuracy performance of the new 2018 periodontitis case definition by the European Federation of Periodontology (EFP)/ American Association of Periodontology (AAP) with Centers for Disease Control (CDC)/AAP 2012 in full-mouth partial recording protocols (PRP). Retrospective data from NHANES 2011-2012 and 2013-2014 were analyzed. For each case definition, full-mouth diagnostic was defined as the reference standard. Patients were diagnosed for the presence of periodontitis and staging for each PRP. Sensitivity, specificity, accuracy and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass ROC/AUC analyses. Our performance analysis shows that the new 2018 classification outperforms the 2012 classification regarding the diagnosis and staging of periodontitis on full-mouth PRPs. This recent case definition has strengthened the utility of PRPs and its improvements certainly explain the observed findings. Also, our findings contribute to the reliability of PRPs and its use in future worldwide epidemiological surveys.
- Accuracy of panoramic radiograph for diagnosing periodontitis comparing to clinical examinationPublication . Machado, Vanessa; Proença, Luís; Morgado, Mariana; Mendes, José João; Botelho, JoãoIn this study, we explore the diagnostic accuracy of a Radiographic-based Periodontal Bone Loss (R-PBL) method as a screening tool for periodontitis, in the form of radiographic bone loss, under the 2018 case definition in comparison to the 2012 case definition. The analysis was based on 456 patients (253 females and 203 males), screened for periodontal status in the Study of Periodontal Health in Almada-Seixal (SoPHiAS) project and subjected to a panoramic dental X-ray. Patients were diagnosed for the presence of periodontitis following the 2018 and 2012 case definition. R-PBL classification was defined by alveolar bone loss and diagnosed as no periodontitis (≥80% remaining alveolar bone), mild to moderate periodontitis (66% to 79%), or severe periodontitis (<66%). We appraise the X-ray quality to look for the influence on the performance of R-PBL. Sensitivity, specificity, accuracy, and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass Receiver operating characteristic/are under the curve (ROC/AUC) analyses. Our results show that the tested R-PBL method under the 2018 case definition is a reliable tool in periodontitis cases screening. This method does not replace clinical periodontal evaluation, but rather, it screens patients towards a definitive periodontitis diagnosis. These results will contribute to support the development of automated prediction systems towards periodontitis surveillance.
- Adaptation and Validation of the Instrument ‘Children Care Quality at Hospital’ for PortuguesePublication . Loureiro, Fernanda; Araújo, Beatriz; Charepe, ZaidaObjective: adapt and validate the instrument Children Care Quality at Hospital (CCQH) to assess the quality of nursing care of hospitalized children for the Portuguese language of Portugal. Materials and Methods: content, language, and conceptual validity methodological study, with translation, feedback, and reflection. A non-probabilistic simple was used of 252 children between 7 and 11 years of age, hospitalized due to acute disease in nine services of six Portuguese hospitals. The reliability and validity of the results were determined to measure the psychometric properties of the instrument. Construct validity was calculated through exploratory factor analysis of main components with Varimax rotation and the internal consistency by determining the Cronbach’s alpha coefficient. Results: the internal consistency has adequate psychometric characteristics suitable for the Portuguese population (Cronbach’s alpha values between 0.66 and 0.82). The instrument maintained 49 items grouped into three categories: characteristics, activities, and environment. The psychometric characteristics of the CCQH, adapted and validated for Portuguese, guarantees its reliability and validity to measure satisfaction with the quality of nursing care from the perspective of school-aged children. Conclusions: the instrument could be used to assess children’s satisfaction with the quality of nursing care during their hospitalization.
- AIS Based Shipping Routes Using the Dijkstra AlgorithmPublication . Silveira, P.; Teixeira, A.P.; Guedes Soares, C.This paper proposes an approach for identifying and characterizing shipping routes using information contained in Automatic Identification System messages broadcasted by ships and recorded by the coastal Vessel Traffic Service centre. The approach consists of using historical Automatic Identification System data to build a graph, where nodes are cells of a grid covering the geographical area being studied and the weights of directional edges are inversely related to ship movements between cells. Based on this graph, the Dijkstra algorithm is used to identify a potential safe route, assumed to be the most used route by ships between two locations. A second graph is created simultaneously, with the same nodes and edges, but with edge weights equal to the average speed of transitions between cells, thus allowing the determination of the average speed profile for any possible path within the graph. The proposed approach is applied to two scenarios: an approach to the port of Lisbon and the entry through the fairway to a RO-RO terminal in the port of Setubal in Portugal.
- Analysing Comovements Between Dirty and Green Energies: An Econometric ApproachPublication . João, Esperança; Dias, Rui; Galvão, Rosa; Alexandre, Paulo; Teixeira, Nuno; Gonçalves, SidalinaThis study analyses the movement patterns between clean energy indices and oil benchmarks such as Brent and WTI from 7 January 2022 to 8 November 2024, intending to verify whether clean energy indices can serve as effective risk diversification instruments. The research focuses on the Nasdaq Clean Edge Green Energy (CELS), S&P Global Clean Energy (SPGTCLEN), Clean Energy Fuels (CLNE) indices and the Invesco Wilderhill Clean Energy (PBW) ETF. The results show that Brent influences the prices of the CELS, CLNE and PBW indices but is unaffected by SPGTCLEN or WTI. WTI has a broad influence, influencing all the other indices. CELS only affects WTI and CLNE, while SPGTCLEN influences CELS and CLNE without influencing the oil markets. CLNE affects CELS, SPGTCLEN and PBW but not Brent or WTI. PBW influences WTI and CLNE but does not affect the other markets. WTI is a key indicator that affects all the other indices, while Brent is the most independent. This indicates that investors can reduce their exposure to oil risk by investing in clean energy indices such as CELS and CLNE, which have limited influences on each other. In conclusion, this study has contributed to understanding the dynamics of movement between clean energy indices and oil benchmarks over the period analysed, offering relevant implications for risk management and portfolio diversification.
- Analysing the Trend and Variability in Corruption Perception: A Study of Sub-Sahara African Countries from 2012-2020Publication . Paul, Chima; Adams, Samuel OlorunfemiThis study examines trends and variability in the Corruption Perception Index (CPI) across 48 Sub-Saharan African (SSA) nation using cross-sectional data from 2012 to 2020 from Transparency International. Based on expert polls, the CPI rates public sector corruption from 0 (high corruption) to 100 (low corruption). Analysis was conducted using STATA 15 and included descriptive statistics, data visualization, correlation matrices, and one-way ANOVA. The findings show a steady yearly growth in the CPI, with major anti-corruption advancements in Botswana, Rwanda, Namibia, and Senegal. While the Democratic Republic of Congo, Sudan, and South Sudan continued to struggle with corruption, Niger, Gabon, Mali, and Togo demonstrated only little progress. The average CPI decreased somewhat from 32.9 in 2012 to 32.2 in 2020, indicating a minor regional impact, notwithstanding individual country efforts. ANOVA results showed no significant variations in corruption levels over time (F = 0.031, P = 0.987), but strong correlations (P < 0.01) suggest persistent CPI trends. These results highlight the necessity of focused policy initiatives and long-term governance reforms to solve persistent corruption problems in SSA. The study concludes that, in spite of evidence of relative effectiveness in governance and anti-corruption initiatives countries like Botswana, Rwanda, Namibia, and Senegal stand out as the top nations with the lowest perceived levels of corruption.
- Analysis of the characteristics and cytotoxicity of titanium dioxide nanomaterials following simulated in vitro digestionPublication . Bettencourt, Ana; Gonçalves, Lídia M.; Gramacho, Ana C.; Vieira, Adriana; Rolo, Dora; Martins, Carla; Assunção, Ricardo; Alvito, Paula; Silva, Maria João; Louro, HenriquetaSeveral metallic nanomaterials (NMs), such as titanium dioxide nanomaterials (TiO2), present beneficial properties with a broad range of innovative applications. The human population is exposed to TiO2, particularly by ingestion, due to its increasing use as a food additive and inclusion in dietary supplements and food packaging materials. Whether this oral exposure may lead to adverse local or systemic outcomes has been the subject of research, but studies have generated contradictory results, reflecting differences in the physicochemical properties of the TiO2 studied, effects of the surrounding matrix, and modifications during digestion. This work aimed to investigate the toxic effects of three different TiO2 NMs (NM-103, NM-103 and NM-105) on the gastrointestinal tract cells, Caco-2 and HT29-MTX-E12, after the use of the standardized static INFOGEST 2.0 in vitro digestion method to mimic human digestion of TiO2, contributing to hazard assessment. The results show that, for one of the digested TiO2 NMs studied (NM-105), a more pronounced toxicity occurs after exposure of HT29-MTX-E12 intestinal cells, as compared to undigested NM, concomitantly with subtle changes in characteristics of the NM. Thus, the inclusion of the digestion simulation in the safety evaluation of ingested NMs through in vitro bioassays can better integrate the modifications that NMs suffer in the organism. It is expected that such an approach will reduce uncertainties in the hazard assessment of ingested NMs for human health.
- Anemia and hematopoietic factor deficiencies in patients after endoscopic gastrostomy: a nine-year and 472-patient studyPublication . Brito, Mariana; Laranjo, Ana; Nunes, Gonçalo; Oliveira, Cátia; Santos, Carla Adriana; Fonseca, JorgeIntroduction and aims: Patients undergoing percutaneous endoscopic gastrostomy (PEG) may present protein-energy malnutrition, anemia and deficiencies of hematopoietic factors, e.g., iron, folate and vitamin B12. There are no comprehensive studies on anemia or other hematological changes in PEG-patients. Our aim was to evaluate the hematological status of dysphagic patients that had undergone PEG and its association with clinical outcome. Methods: This research comprises a retrospective study of patients followed by our Artificial Feeding Team, submitted to PEG from 2010 to 2018. Patients were divided into two etiological groups: neurological dysphagia (ND) and head/neck or esophageal disorders (HNE). Laboratory data included serum albumin, hemoglobin, mean corpuscular volume, ferritin, transferrin, iron, vitamin B12 and folate. Survival after PEG was recorded in months, until death or December 2018. Results: We evaluated 472 patients; 250 (53%) presented anemia at the moment of gastrostomy, mostly normocytic (n = 219), with laboratory data suggestive of anemia of chronic disease (ACD). Six patients (1.3%) presented vitamin B12 deficiency and 57 (12.1%) presented folate deficit. No statistically significant difference in hemoglobin was found between the etiological groups (p = 0.230). Folate and vitamin B12 levels were lower in the HNE group (p < 0.01). A positive correlation between hemoglobin and survival was present (p < 0.01, r = 0.289), and hemoglobin levels were lower in the deceased population (p < 0.01). Conclusion: Anemia is frequent in PEG-patients, mostly with the features of ACD or multifactorial. It is associated with significant decrease in survival and may be viewed as a marker of severe metabolic distress, signaling poor outcome.
- Are cariogenic bacteria the major risk factor to dental caries in patients with ulcerative colitis?Publication . Rodrigues, Eduardo; Laranjeira, Nuno; Nunes, Gonçalo; Roque-Ramos, Lídia; Vieira, Ana; Fonseca, JorgeBackground – High prevalence of dental caries in ulcerative colitis (UC) has been attributed to diet and changes in salivary environment. Objective – We aimed to characterize the prevalence of dental caries, salivary flow rates, salivary buffering capacity and cariogenic bacteria counts of Mutans streptococci and Lactobacillus spp and to evaluate their relationship with drug therapy, disease activity and duration. Methods – A cross-sectional study was performed with UC patients followed in a tertiary center. Participants were submitted to a questionnaire (including demographic data, oral hygiene, eating habits) and a clinical observation with assessment of plaque index and Decayed, Missing and Filled Teeth index. Unstimulated/stimulated saliva was collected. Medical records, disease activity (Partial Mayo Score) and disease duration were collected. Laboratory data included salivary flow rates, salivary buffering capacity (CRT® buffer) and cariogenic bacteria count (Mutans streptococci and Lactobacillus spp) in saliva using the CRT® bacteria test (results: high or low counts). Results – Thirty UC patients were recruited. Oral hygiene routines were daily teeth brushing once or more (96.7%) and fluoride toothpaste (73.3%). Decayed, Missing and Filled Teeth index (mean 16.17±6.428) was not affected by the frequency of soft drinks, cakes, sweets and sugars between meals (P>0.2). Long-term disease showed a trend towards higher prevalence of caries (P=0.06). Most presented normal salivary flow rates, unstimulated (73.3%) and stimulated (60.0%), and high salivary buffering capacity (66.7%). Any association was found with age, gender, disease activity, disease duration and drug therapy. High Mutans streptococci and low Lactobacillus spp count were observed in 73.3% and 60% of patients, respectively. Patients with active disease (100%) and longer duration (88.9%) displayed higher Mutans streptococci count. Conclusion – The prevalence of dental caries observed in UC patients was significant and did not seem to be influenced by their eating habits. The high prevalence of Mutans streptococci count may be a major risk factor for dental caries and may be looked as part of the UC dysbiosis. Dental care of UC patients should be planned according with this microbiota variation
- Are Precious Metals Hedging Assets for Clean Energy Indices?Publication . Amândio, Helena; Dias, Rui; Galvão, Rosa; Alexandre, Paulo; Gonçalves, Sidalina; Leote, FranciscoThis study aims to analyse whether precious metals can be hedged assets concerning green energy indices from 8 January 2019 to 6 December 2024. About precious metals, the futures market was analysed: copper (HGH5) and silver (SIH5), the gold spot market (XAU) was also included to provide robustness, and the green indices are S&P Global Clean Energy (SPGTCLEN), NASDAQ Clean Edge Green Energy (CELS), and the iShares Global Clean Energy ETF (ICLN). The sample was divided into four sub periods: 8 January 2019 to 31 December 2019, referred to as Pre-Covid-19; the second sub-period, referred to as the first Covid-19 Wave, comprises the period from 2 January 2020 to 31 December 2020; the second Covid-19 Wave includes the years from 2 January 2021 to 23 February 2022; Finally, the last sub-period, called Conflict, covers the years from 24 February 2022 to 6 December 2024. The green indices (CELS, ICLN, SPGTCLEN) showed extremely high correlations with each other in all periods, reducing the effectiveness of diversification in the sector. Gold remained a consistent, safe haven asset, with negative or very low correlations with the green indices, especially during global crises. Silver evolved from moderate to negative correlations with the green indices, reinforcing its usefulness as a hedging asset. Copper, initially positively correlated with green indices, has exhibited negative correlations recently, making it a strategic asset in portfolios with green energy assets. It was also found that only copper (HGH5) was contagious during the first wave of COVID-19, which validates the evidence found earlier through unconditional correlations. In conclusion, these results highlight that gold and silver effectively protect against market shocks, while copper can be used as a diversifying asset in green energy portfolios, thus requiring differentiated strategies to maximise diversification benefits.