Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles

OBJECTIVE: Despite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland.

METHODS: CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.

RESULTS: Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25-84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8-7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1-3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2-5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8-9.0%. These projections remained stable under a wide range of sensitivity analyses.

CONCLUSIONS: Feasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

Nonsteroidal Anti-Inflammatory Drug Use is Not Associated With Reduced Risk of Barrett’s Esophagus

OBJECTIVES: Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced risk of esophageal adenocarcinoma. Epidemiological studies examining the association between NSAID use and the risk of the precursor lesion, Barrett’s esophagus, have been inconclusive.

METHODS: We analyzed pooled individual-level participant data from six case-control studies of Barrett’s esophagus in the Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON). We compared medication use from 1474 patients with Barrett’s esophagus separately with two control groups: 2256 population-based controls and 2018 gastroesophageal reflux disease (GERD) controls. Study-specific odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression models and were combined using a random effects meta-analytic model.

RESULTS: Regular (at least once weekly) use of any NSAIDs was not associated with the risk of Barrett’s esophagus (vs. population-based controls, adjusted OR = 1.00, 95% CI = 0.76–1.32; I2=61%; vs. GERD controls, adjusted OR = 0.99, 95% CI = 0.82–1.19; I2=19%). Similar null findings were observed among individuals who took aspirin or non-aspirin NSAIDs. We also found no association with highest levels of frequency (at least daily use) and duration (≥5 years) of NSAID use. There was evidence of moderate between-study heterogeneity; however, associations with NSAID use remained non-significant in “leave-one-out” sensitivity analyses.

CONCLUSIONS: Use of NSAIDs was not associated with the risk of Barrett’s esophagus. The previously reported inverse association between NSAID use and esophageal adenocarcinoma may be through reducing the risk of neoplastic progression in patients with Barrett’s esophagus.

Sistemas de informação para DNA microarrays

O projecto de sequenciação do genoma humano veio abrir caminho para o surgimento de novas áreas transdisciplinares de investigação, como a biologia computacional, a bioinformática e a bioestatística. Um dos resultados emergentes desde advento foi a tecnologia de DNA microarrays, que permite o estudo do perfil da expressão de milhares de genes, quando sujeitos a perturbações externas. Apesar de ser uma tecnologia relativamente consolidada, continua a apresentar um conjunto vasto de desafios, nomeadamente do ponto de vista computacional e dos sistemas de informação. São exemplos a optimização dos procedimentos de tratamento de dados bem como o desenvolvimento de metodologias de interpretação semi-automática dos resultados. O principal objectivo deste trabalho consistiu em explorar novas soluções técnicas para agilizar os procedimentos de armazenamento, partilha e análise de dados de experiências de microarrays. Com esta finalidade, realizou-se uma análise de requisitos associados às principais etapas da execução de uma experiência, tendo sido identificados os principais défices, propostas estratégias de melhoramento e apresentadas novas soluções. Ao nível da gestão de dados laboratoriais, é proposto um LIMS (Laboratory Information Management System) que possibilita a gestão de todos os dados gerados e dos procedimentos realizados. Este sistema integra ainda uma solução que permite a partilha de experiências, de forma a promover a participação colaborativa de vários investigadores num mesmo projecto, mesmo usando LIMS distintos. No contexto da análise de dados, é apresentado um modelo que facilita a integração de algoritmos de processamento e de análise de experiências no sistema desenvolvido. Por fim, é proposta uma solução para facilitar a interpretação biológica de um conjunto de genes diferencialmente expressos, através de ferramentas que integram informação existente em diversas bases de dados biomédicas.

From genes to population: effects of toxicants on Enchytraeus albidus

Nowadays, a systems biology approach is both a challenge as well as believed to be the ideal form of understanding the organisms’ mechanisms of response. Responses at different levels of biological organization should be integrated to better understand the mechanisms, and hence predict the effects of stress agents, usable in broader contexts. The main aim of this thesis was to evaluate the underlying mechanisms of Enchytraeus albidus responses to chemical stressors. Therefore, there was a large investment on the gene library enrichment for this species, as explained ahead. Overall, effects of chemicals from two different groups (metals and pesticides) were assessed at different levels of biological organization: from genes and biochemical biomarkers to population endpoints. Selected chemicals were: 1) the metals cadmium and zinc; 2) the insecticide dimethoate, the herbicide atrazine and the fungicide carbendazim. At the gene and sub-cellular level, the effects of time and dosage were also adressed. Traditional ecotoxicological tests - survival, reproduction and avoidance behavior - indicated that pesticides were more toxic than metals. Avoidance behaviour is extremely important from an ecological point of view, but not recommended to use for risk assessment purposes. The oxidative stress related experiment showed that metals induced significant effects on several antioxidant enzyme activities and substrate levels, as well as oxidative damage on the membrane cells. To increase the potential of our molecular tool to assess transcriptional responses, the existing cDNA library was enriched with metal and pesticide responding genes, using Suppression Subtractive Hybridization (SSH). With the sequencing information obtained, an improved Agilent custom oligonucleotide microarray was developed and an EST database, including all existing molecular data on E. albidus, was made publicly available as an interactive tool to access information. With this microarray tool, most interesting and novel information on the mechanisms of chemical toxicity was obtained, with the identification of common and specific key pathways affected by each compound. The obtained results allowed the identification of mechanisms of action for the tested compounds in E. albidus, some of which are in line with the ones known for mammals, suggesting across species conserved modes of action and underlining the usefulness of this soil invertebrate as a model species. In general, biochemical and molecular responses were influenced by time of exposure and chemical dosage and these allowed to see the evolution of events. Cellular energy allocation results confirmed the gene expression evidences of an increased energetic expenditure, which can partially explain the decrease on the reproductive output, verified at a later stage. Correlations found throughout this thesis between effects at the different levels of biological organization have further improved our knowledge on the toxicity of metals and pesticides in this species.

Conversations with remarkable teachers an exploration of teaching as healing

Through analysis and interpretation of transcribed taped conversations with two remarkable University teachers, Joel Shack and Harry Whittier, an articulation of perception and metaphor that exists in effective teaching, emerges as life giving or transformational. Creative insight and interpretation connect teaching to life. This work demonstrates how insightful conversations about teaching relate to poetic essence (Joel), energy (Harry), and healing (Ray), all aspects of a similar perceptual, creative and transformative process. Teachers shape education and excellent teaching inspires insofar as it is inspirited. Effective teaching is highly conscious and intentional. So much depends on how aware the teacher is, how the teacher sees what s/he is doing and how this doing/teaching is received. The effective teacher, attentive to how this energy works, can provoke positive change in consciousness both in the student, in education and in society. My study draws attention to the healing power of the teacher as he/she teaches and to the process of dialogue as teachers talk about what they do and don't do. For inherent in conversation and dialogue is the desire to affirm whole perceptions of existence. Dialogue and conversation is necessary to creating the kind of consciousness that will aid the reflective and conscientious teacher. The effective teacher attempts to effect change, to make things better. I call this transforming process, healing. And what creates this healing is the life, the attitude and approach of the teacher. The teacher's energy and consciousness, the teacher's perception of meaning, is the active but implicit ingredient in this transformative and healing process. These conversations are creative, theoretical, illuminating and even practical. It is my hope that the contents of these conversations will inspire potential teachers who can consider the vocation of teaching as a healing process that promises to generate positive growth in mind, body and spirit.

Sistemas informáticos em saúde para a qualidade dos cuidados de enfermagem, revisão sistemática

Dissertação de mestrado, Gestão de Unidades de Saúde, Faculdade de Economia, Universidade do Algarve, 2015