Health-related quality of life in portuguese SLE patients: an outcome measure independent of disease activity and cumulative damage

PURPOSE: To evaluate quality of life in Portuguese patients with Systemic Lupus Erithematosus (SLE) and its correlation with disease activity and cumulative damage. METHODS: We included consecutive SLE patients, fulfilling the 1997 ACR Classification Criteria for SLE and followed at the Rheumatology Department of the University Hospital of Coimbra, Portugal at time of visit to the outpatient clinic. Quality of life was evaluated using the patient self-assessment questionnaire Medical Outcomes Survey Short Form-36 (SF-36) (validated Portuguese version). The consulting rheumatologist fulfilled the SLE associated indexes for cumulative damage (Systemic Lupus International Collaborating Clinics- Damage Index: SLICC/ACR-DI) and disease activity (Systemic Lupus Erythematosus Disease Activity Index: SLEDAI 2000). Correlation between SLEDAI and SLICC and SF-36 was tested with the Spearman Coefficient. Significant level considered was 0.05. RESULTS: The study included 133 SLE patients (90.2% female, mean age - 40.7 years, mean disease duration - 8.7 years). Most patients presented low disease activity (mean SLEDAI = 4.23) and limited cumulative damage (mean SLICC = 0.76). Despite that, SF-36 mean scores were below 70% in all eight domains of the index. Physical function domains showed lower scores than mental function domains. The QoL in this group of patients is significantly impaired when compared with the reference Portuguese population (p<0.05 in all domains). There was no correlation between clinical activity or cumulative damage and quality of life. CONCLUSION: QoL is significantly compromised in this group of SLE patients, but not related with disease activity or damage. These findings suggest that disease activity, cumulative damage and QoL are independent outcome measures and should all be used to assess the full impact of disease in SLE patients.

Food and fuel microalgae applications: insights from portuguese experience [Resumo]

Microalgae have a wide range of application fields, from food to fuels, to pharmaceuticals & fine chemicals, aquaculture and environmental bioremediation, among others. Spirulina and Chlorella have been used as food sources since ancient times, due to their high and balanced nutritional value. Our research group in Lisbon has developed a range of food products (emulsions, gelled desserts, biscuits and pastas) enriched with freshwater and marine microalgae (Spirulina, Chlorella, Haematococcus, Isochrysis and Diacronema). The developed products presented attractive and stable colours, high resistance to oxidation and enhanced rheological properties. Some of these products will be prepared at the Post-Congress Course “Functional Foods Development” at the University of Antofagasta. More recently, a great interest has arisen on using microalgae for biofuel production. The same group has also been exploring several marine and freshwater species for biofuel production (e.g., biodiesel, bioethanol, biohydrogen and biomethane) within a biorefinery approach, in order to obtain high and low-value co-products using integral biomass maximizing the energy revenue. Namely, supercritical fluid extraction of Nannochloropsis sp. allowed the recovery of valuable carotenoids and lipids, prior to bioH2 production through dark fermentation of the residual biomass. Also, Scenedesmus obliquus residues after sugars (for bioethanol) and lipids (for biodiesel) extraction has been anaerobically digested attaining high biomethane yields. Regarding sustainability issues, the current trend of our group is now focused on using liquid effluents and high CO2 levels for low cost microalgae growth, contributing to a lower water demand, primary energy consumption and global warming potential by reducing the need for potable water and fertilizers (P, N) and increasing CO2 mitigation. Microalgae biomass has been successfully used for urban wastewater treatment with subsequent bioH2 production, in a biorefinery approach. Presently, ammonium-rich raw effluents from piggeries and poultry industry are being effectively used for microalgae growth avoiding any pre-treatment step.

Assessment of fungal contamination in a Portuguese maternity unit

A descriptive study was developed to monitor air fungal contamination in one Portuguese maternity. Sixty air samples were collected through impaction method. Air sampling was performed in food storage facilities, kitchen, food plating, canteen, pharmacy, sterilization areas, genecology wards, intensive care unit, operating rooms, urgency and also, outside premises, since this was the place regarded as reference. Besides air samples, forty three samples were collected by swabbing the surfaces using a 10 by 10 cm square stencil. Simultaneously, temperature, relative humidity and particles counting (PM10) were registered. Twenty three species of fungi were identified in air, being the two most commonly isolated the genera Penicillium (41,5%) and Cladosporium (28,4%). Regarding yeasts, only Rhodotorula sp. (45,2%), Trichosporon mucoides (51,6%) and Cryptococcus neoformans (3,2%) were found. Thirteen species of fungi were identified in surfaces, being the most frequent the Penicillium genus (91,6%). Concerning yeasts found in surfaces, four species were identified being Rhodotorula sp. (29,1%) the most frequent. There was no coincidence between prevailing genera indoors and outside premises. Moreover, some places presented fungal species different from the ones isolated outside. In the inside environment, Aspergillus species were isolated in air and surfaces. There was no significant relationship (p>0,05) between fungal contamination and the studied environmental variables. Keywords: air, surfaces, fungal contamination, environmental variables, maternity.

Determinants of self-medication with NSAIDs in a Portuguese community pharmacy

Background: Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used therapeutic group in the world, and particularly in the Portuguese population. Objective: To compare NSAID’s use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients’ safety. Methods: A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month) were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved. Results: A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5 years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients (n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7) had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%), regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%). One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects. Conclusion: Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident) confirm the need for a more rational use of NSAIDs and ongoing pharmacovigilance.

Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

Acoustic characterisation of the tonic syllable in portuguese

A particular problem for the automatic prediction of prosody in speech synthesis is the realisation of accented syllables since these are affected by many parameters and are perceptually very salient. For the Portuguese language, in Europe, a set of comprehensive quantitative characterisation data and rules is totally lacking. The present paper is intended to be a quantitative contribution to the solution of this problem. In this paper, a preliminary modelling of duration, intensity and variation of F0 in the tonic syllable will be presented. The dependencies of the model with the syllable position in the word and the word position in the phrase are also presented.

Impact of using solar heat pumps for domestic hot water in Portuguese residential buildings

In recent years, we have seen an improvement of existing facilities in dwellings in Portugal. Within the heat pumps systems, there is a special type known as direct expansion heat pump assisted by Solar Collector (DX-SAHP). It was calculate the SPF indicator for 30 regions of Portugal. It was analyses the potential of reductions of CO2 and primary energy use for the retrofitting of DHW preparation systems. It was found that the performances of this type of equipment are benefiting from the Portuguese climate conditions, especially in the South and in the Autonomous Regions. Best SPF was obtained for Beja. It was found in all regions of the high potential for reducing CO2 emissions and verifying a potential significant reduction of primary energy consumption.

Application of the nZEB methodology in the retrofitting of a typical Portuguese dwelling from the 60's.

Buildings and the whole built environment are in a key role when societies are mitigating climate change and adapting to its consequences. More than 50% of the existing residential buildings in EU-25 were built before 1970. Thus, these buildings are of significant importance in reducing energy consumption and CO2 emissions. The existence of more nearly zero energy buildings (nZEB) is a possible solution for this problem. This study aims to analyze the application of the nZEB methodology in the retrofitting of a typical Portuguese dwelling build in 1950. It was shown that the primary energy used can be reduced to a very low value (11,95 kWhep/m2.y) in comparison with the reference consumption (69,15 kWhep/m2.y), with the application of the best construction techniques together with the use of energy from on-site renewable sources.