Browsing by Author "Furtado, Cristina"
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- Aspergillus em ambiente hospitalar: um risco para o desenvolvimento de infeções nosocomiais?Publication . Raquel, Sabino; Veríssimo, Cristina; Viegas, Carla; Brandão, João; Parada, Helena; Martins, Carlos; Furtado, Cristina; Clemons, Karl V.; Stevens, David A.
- Citomegalovírus: análise retrospetiva de casos suspeitos de infeção do sistema nervoso central, diagnosticados entre 2010 e 2014Publication . Lopo, Sílvia; Reis, Tânia; Palminha, Paula; Vinagre, Elsa; Furtado, CristinaEste estudo tem como objetivo descrever as características demográficas e o quadro clínico e imunitário de doentes com suspeita de infeção viral neurotrópica e analisar a frequência das infeções por CMV nas patologias do SNC, cujo diagnóstico foi confirmado no Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA) entre janeiro de 2010 e abril de 2014.
- Colaboração intersetorial na investigação de surtos numa abordagem "Uma Só Saúde": resultados de um exercício de simulação a nível nacional de resposta a um surto de origem alimentarPublication . Manageiro, Vera; Caria, Ana; Furtado, Cristina; SimEx Portuguese Team; Botelho, Ana; Oleastro, Mónica; Gonçalves, Sandra CavacoA colaboração intersetorial é uma componente essencial da abordagem "Uma Só Saúde" (One Health), que reconhece a interligação entre a saúde dos seres humanos, dos animais e do ambiente. O Programa OHEJP (One Health European Joint Programme) desenvolveu um exercício nacional de simulação de surtos de origem alimentar (OHEJP SimEx) com o objetivo de promover a capacitação e interoperabilidade entre os setores da saúde pública, saúde animal e segurança alimentar. Em Portugal, o OHEJP SimEx destacou a importância do conhecimento dos sistemas disponíveis, das limitações da legislação existente, da importância da harmonização e partilha de dados e da elaboração de mensagens comuns adaptadas a cada setor-alvo. No entanto, há ainda um longo caminho a percorrer para assegurar a cooperação entre os vá- rios setores, uma vez que uma abordagem de “Uma Só Saúde” depende não só da sensibilização e formação dos "especialistas no terreno", mas também da vontade e do empenho políticos e organizacionais.
- Detection of Dientamoeba fragilis in Portuguese children with acute gastroenteritis between 2011 and 2013Publication . Júlio, C.; Furtado, Cristina; Rocha, R.; Escobar, C.; Brito, M.J.; Oleastro, MónicaDientamoeba fragilis is an inhabitant of human gastrointestinal tract with a worldwide distribution. The first description considered this protozoan a rare and harmless commensal, since then it has struggled to gain recognition as a pathogen. Commercial multiplex real-time PCR was used to detect D. fragilis in fecal samples from hospitalized children (⩽18 years) with acute gastrointestinal disease, admitted to two hospitals of Lisbon area, with different demographic characteristics. A total of 176 children were studied, 103 (58·5%) male, 144 (81·8%) children between 0 and 5 years and 32 (18·2%) above 6 years old. The overall protozoa frequency considering the four tested microorganisms were 8·5% (15/176), and the most frequently found protozoan was D. fragilis, 6·3% (11/176). Dientamoeba fragilis frequency was higher among older children (21·9%), than younger children (2·8%), and greater in boys (6·8%) than in girls (5·5%). All positive children presented with diarrhoea associated with vomiting, fever and abdominal pain. Infection was associated with the age of children (P < 0·001), school attendance (P = 0·002) and consumption of certain foods (P = 0·014), e.g. cakes with crème and ham. The frequency of diantamoebiasis found in a cohort of hospitalized Portuguese children, with acute gastrointestinal disease, could be considered a very high value when compared with the protozoan frequency normally associated with this pathology.
- Diagnóstico diferencial de vírus respiratórios em casos de síndroma gripal no inverno 2013/2014Publication . Pechirra, Pedro; Cristóvão, Paula; Maia, Ana Carina; Conde, Patrícia; Furtado, Cristina; Guiomar, Raquel
- Doença meningocócica do serogrupo B (MenB) em Portugal: uma reflexão sobre estratégias de imunizaçãoPublication . Simões, Maria João; Fernandes, Teresa; Gonçalves, Paulo; Bettencourt, Célia; Furtado, Cristina
- As doenças raras na Europa: o enquadramento portuguêsPublication . Gómez, Verónica; Rama, Patrícia; Machado, Ausenda; Braz, Paula; Furtado, Cristina; David, Dezső; Miranda, Natércia; Isidro, GlóriaA EUCERD Joint Action (EJA) para as Doenças Raras (DR) integrou cinco domínios: planos nacionais e estratégias, nomenclatura internacional para DR, serviços sociais especializados, qualidade dos cuidados/centros de referência e integração de iniciativas em DR. O objetivo deste artigo é descrever o enquadramento português nas DR. Em novembro de 2014 foi realizado um workshop em Portugal com oito países participantes. Foi descrita a situação europeia para as DR e comparada com a realidade portuguesa. Estiveram presentes: autoridades europeias, parceiros da EJA, especialistas, investigadores, profissionais de saúde e associações de doentes. Realizou-se uma análise qualitativa dos conteúdos das apresentações, posteriormente atualizada através de análise documental. No domínio dos planos e estratégias foi aprovada a Estratégia Integrada para as Doenças Raras 2015-2020 que assenta numa cooperação interministerial, intersectorial e interinstitucional. Em relação à nomenclatura, foi discutida e proposta a utilização do Orphanumber. Foram descritas várias iniciativas no âmbito das DR e observados exemplos de boas práticas na área dos serviços socias especializados. Recentemente, Portugal reconheceu oficialmente vários Centros de Referência Nacionais, onde se incluem alguns para as DR. Em conclusão, Portugal tem vindo a desenvolver diversas atividades no domínio das DR sendo necessário continuar com a integração das mesmas.
- Effects of economic recession on elderly patients' perceptions of access to health care and medicines in PortugalPublication . da Costa, Filipa Alves; Teixeira, Inês; Duarte-Ramos, Filipa; Proença, Luís; Pedro, Ana Rita; Furtado, Cristina; da Silva, José Aranda; Cabrita, JoséBackground In view of the current financial and demographic situation in Portugal, accessibility to health care may be affected, including the ability to adhere to medication. Objective To evaluate the perceived effects of the crisis on elderly patient's access to medicines and medical care, and its implications on medicine-taking behaviour. Setting Community pharmacy. Method A cross-sectional study was undertaken during April 2013, where elderly patients answered a self-administered questionnaire based on their health-related experiences in the current and previous year. Binary logistic regression was used to ascertain the effects of potential predictors on the likelihood of adherence. Main outcome measures self-reported adherence. Results A total of 1231 questionnaires were collected. 27.3% of patients had stopped using treatments or health services in the previous year for financial motives; mostly private medical appointments, followed by dentist appointments. Almost 30% of patients stopped purchasing prescribed medicines. Over 20% of patients reduced their use of public services. Out-of-pocket expenses with medicines were considered higher in the current year by 40.1% of patients. The most common strategy developed to cope with increasing costs of medicines was generic substitution, but around 15% of patients also stopped taking their medication or started saving by increasing the interdose interval. Conclusion Reports of decreasing costs with medicines was associated with a decreased likelihood of adherence (OR 0.42; 95% CI 0.27-0.65). Lower perceived health status and having 3 or more co-morbidities were associated with lower odds of adhering, whilst less frequent medical appointments was associated with a higher likelihood of exhibiting adherence.
- Excess Mortality Estimation During the COVID-19 Pandemic: Preliminary Data from PortugalPublication . Nogueira, Paulo Jorge; De Araújo Nobre, Miguel; Nicola, Paulo Jorge; Furtado, Cristina; Vaz Carneiro, AntónioIntroduction: Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria for estimating excessive all-causes mortality during the early COVID-19pandemic period. Material and Methods: Public data was used to estimate excess mortality by age and region between March 1 and April 22, proposing baselines adjusted for the lockdown period. Results: Despite the inherent uncertainty, it is safe to assume an observed excess mortality of 2400 to 4000 deaths. Excess mortality was associated with older age groups (over age 65). Discussion: The data suggests a ternary explanation for early excess mortality: COVID-19, non-identified COVID-19 and decrease in access to healthcare. The estimates have implications in terms of communication of non-pharmaceutical actions, for research, and to healthcare professionals. Conclusion: The excess mortality occurred between March 1 and April 22 was 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths.
- Genomic and epidemiological insight of an outbreak of carbapenemase-producing Enterobacterales in a Portuguese hospital with the emergence of the new KPC-124Publication . Manageiro, Vera; Cano, Manuela; Furtado, Cristina; Iglesias, Carmen; Reis, Lígia; Vieira, Patrícia; Teixeira, Aida; Martins, Cláudia; Veloso, Isabel; Machado, Jorge; Paiva, José Artur; Caniça, ManuelaBackground: Carbapenemase-producing Enterobacterales (CPE) is an increasing problem in healthcare settings. This study aimed to identify the source of a CPE outbreak that occurred in 2022, in a tertiary hospital in the North of Portugal, to identify exposed patients, and to assess the risk of becoming CPE-positive following hospital admission. Methods: A multi-disciplinary investigation was conducted including descriptive, analytical, and molecular epidemiology, environmental screening, and assessment of infection control measures. Clinical and environmental isolates were analyzed using whole-genome sequencing and phylogenetic analysis. Additionally, a prospective observational cohort study was conducted to further investigate the risk factors associated with the emergence of new cases in cohorts of CPE-negative admitted patients. Results: We observed the presence of multispecies KPC-, IMP-, and/or NDM-producing isolates. Genetically indistinguishable clinical and environmental isolates were found on the same room/ward. The ST45 KPC-3-producing Klebsiella pneumoniae clone was the responsible for the outbreak. During patients' treatment, we detected the emergence of resistance to ceftazidime-avibactam, associated with mutations in the blaKPC-3 gene (blaKPC-46, blaKPC-66 and blaKPC-124, the last variant never previously reported), suggesting a vertical evolutionary trajectory. Patients aged ≥ 75 years, hygiene/feeding-care dependent, and/or subjected to secretion aspiration were risk factors for CPE colonization after hospital admission. Additionally, cases with previous admission to the emergency department suggest that CPE dissemination may occur not only during hospitalization but also in the emergency department. Conclusion: Overall, the study highlights that selection pressure with antibiotics, like ceftazidime-avibactam, is a contributing factor to the emergence of new β-lactamase variants and antibiotic resistance. It also shows that the hospital environment can be a significant source of CPE transmission, and that routine use of infection control measures and real-time molecular epidemiology investigations are essential to ensure the long-term termination of CPE outbreaks and prevent future resurgences.
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