Percorrer por autor "Nogueira, Paulo"
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- Air conditioning and intrahospital mortality during the 2003 heatwave in Portugal: evidence of a protective effectPublication . Nunes, Baltazar; Paixão, Eleonora; Dias, Carlos Matias; Nogueira, Paulo; Falcão, José MarinhoObjectives - The objective of the study was to analyse the association between the presence of air conditioning in hospital wards and the intrahospital mortality during the 2003 heatwave, in mainland Portugal. Methods Historical cohort study design including all patients aged 45 or more who were hospitalised in the 7 days before the heatwave. The outcome was survival during the 18 days the heatwave lasted and during the 2 days after the end of the heatwave. A comparison group was also selected in four analogous periods without any heatwave event during January to May 2003. Data were obtained from the 2003 hospital discharges database. Air conditioning presence in hospital wards was determined using a survey sent to hospital administrations. A Cox-regression model was used to estimate the confounder-adjusted HR of death, during the heatwave and the comparison period, in patients in wards with air conditioning (AC+) versus patients in wards without air conditioning (AC−). Results 41 hospitals of mainland Portugal (49% of all hospitals in mainland Portugal) participated, and 2093 patients were enrolled. The overall confounder-adjusted HR of death in AC+ patients versus AC− patients was 0.60 (95% CI 0.37 to 0.97) for the heatwave period and 1.05 (95% CI 0.84 to 1.32) for the comparison group. Conclusions The study found strong evidence that, during the August 2003 heatwave, the presence of air conditioning in hospital wards was associated with an increased survival of patients admitted before the beginning of the climate event. The reduction of the risk of dying is estimated to be 40% (95% CI 3% to 63%).
- Ar condicionado e mortalidade intra-hospitalar durante a onda de calor de 2003: evidência de um efeito protectorPublication . Nunes, Baltazar; Paixão, Eleonora; Dias, Carlos Matias; Nogueira, Paulo; Falcão, José MarinhoEm Portugal, ocorreu uma onda de calor em Agosto de 2003, que foi responsável por um excesso de mais de 1900 óbitos. A nível Europeu é também conhecido que esta onda de calor foi responsável por um excesso de cerca de 70000 óbitos. Uma parte apreciável do excesso de mortalidade verificada, durante esta onda de calor, ocorreu em estabelecimentos hospitalares. Desde então, o Plano de Contingência para as Ondas de Calor (PCOC) recomenda a climatização dos hospitais como medida essencial para diminuição da mortalidade intrahospitalar. O objectivo deste estudo foi avaliar a associação entre a mortalidade intra-hospitalar e a existência de ar condicionado nos serviços de internamento durante a onda de calor de 2003 em Portugal continental. Foi delineado um estudo de coortes histórico, incluindo todos os doentes com idade igual ou superior a 45 anos que estiveram hospitalizados durante os 7 dias antes do inicio da onda de calor e que, por isso, foram expostos ao excesso de calor apenas no hospital. O critério de avaliação principal do estudo foi a sobrevivência dos doentes nos 18 dias de ocorrência da onda de calor, mais um período de 2 dias, uma vez que a mortalidade ainda tem repercussões durante alguns dias imediatamente a seguir às ondas de calor. Este critério foi utilizado para comparação entre os doentes em serviços com ar condicionado (AC+) e os doentes em serviços sem ar condicionado (AC-). Os dados sobre os internamentos hospitalares foram retirados da base de dados dos Grupos de Diagnóstico Homogéneo (GDH) de 2003, que contém todos os episódios de internamento registados nos hospitais do Serviço Nacional de Saúde (SNS) de Portugal continental, e que tiveram alta em 2003. A informação sobre a existência de ar condicionado, nos diversos serviços dos hospitais do SNS, foi obtida através de um inquérito dirigido às Administrações de cada hospital, que decorreu entre os meses de Abril a Julho de 2007.
- Centro de Estudos e Registo de Anomalias Congénitas: relatório 1997Publication . Feijóo, Maria; Soares, Maria; Braz, Paula; Nogueira, Paulo; Dias, Carlos MatiasPrimeiro relatório, não exaustivo, do Registo Nacional de Anomalias Congénitas, coordenado pelo Centro de Estudo e Registo de Anomalias Congénitas. Registo nosológico de base populacional que apresenta neste relatório os dados referentes ao ano de 1997. Foram recebidas 1585 notificações de casos de anomalias congénitas detetadas em recem-nascidos vivos, fetos mortos e fetos resultantes de interrupções médicas da gravidez.As anomalias foram classificadas de acordo com a 9ª classificação internacional de doenças e causas de morte (CID9) e o grupo mais prevalente foi o das anomalias cardiovasculares, seguindo-se os grupos das anomalias dos membros, urogenitais e musculo-esqueleticas.
- Comportamentos das Famílias Portuguesas em Épocas de Calor e Durante a Onda de Calor de Agosto de 2003Publication . Nogueira, Paulo; Paixão, Eleonora; Falcão, José MarinhoEste estudo teve como principal objectivo a caracterização das atitudes e da adopção de medidas de protecção em períodos de calor e em particular conhecer aquelas que efectivamente foram adoptadas durante a onda de calor de Agosto de 2003 (29 de Julho a 15 de Agosto). Foi realizado um inquérito por via postal, aplicando um questionário aos indivíduos de 18 e mais anos das unidades de alojamento (UA), que constituem a amostra ECOS (Em Casa Observamos Saúde) do Observatório Nacional de Saúde. Estudaram-se 769 indivíduos, o que correspondeu a 25,6% da totalidade dos indivíduos elegíveis nas UA. Uma vez que a amostra ECOS não é autoponderada, foram ponderados os resultados das unidades de alojamento pela variável do Instituto Nacional de Estatística (INE) «número de famílias clássicas» por região e pela «população residente segundo o nível de instrução» obtidas pelos censos de 2001. Os comportamentos referidos como adoptados em épocas de calor que apresentaram maiores percentagens foram «tomar duches ou banhos» (84,6%), «ingestão de líquidos» (79,6%), «uso de roupa leve, larga e clara» (73,2%) e «tomar refeições leves» (53,7%). Durante a onda de calor de 2003, a maior parte da população (92,5%) leu, ouviu ou viu informação sobre os cuidados a ter durante a onda de calor, tendo sido a televisão (95,2%), a rádio (56,3%) e os jornais (49,3%) os meios de comunicação social mais referidos. Cerca de metade da população (51,4%) informou alguém, fundamentalmente a família, sobre os cuidados a ter. Com efeito, durante esta onda de calor verificou-se um maior cuidado em relação a comportamentos mais prejudiciais em épocas de maior calor. Por um lado, a população portuguesa andou menos ao sol (49,4%), fez menos viagens de carro/transportes à hora do calor (39,8%), realizou menos actividades que exigiriam esforço físico (32,5%) e também houve alguma preocupação em beber menos bebidas alcoólicas (26,5%). Por outro lado, aumentaram os comportamentos que já são mais habituais durante o período de Verão, tais como abrir as janelas durante a noite (40,8%), tomar refeições leves (46,7%), tomar mais duches ou banhos (58,5%), o uso de roupas leves largas e claras (42,5%) e o uso de ventoinhas (37,8%). A alteração do comportamento andar ou estar ao sol sem restrições aumenta com o número de meios de comunicação onde se obteve informação. Abrir as janelas de casa durante a noite e tomar duches ou banhos apresentou uma associação com o número de meios de comunicação onde se obteve informação e com o número de pessoas que prestaram informação. Ingerir líquidos e usar roupa leve, larga e clara mostrou também uma dependência do número de meios de comunicação onde se obteve informação.
- Epidemiology and genetic diversity of invasive Neisseria meningitidis strains circulating in Portugal from 2003 to 2020Publication . Bettencourt, Célia; Nunes, Alexandra; Nogueira, Paulo; Duarte, Sílvia; Silva, Catarina; Gomes, João Paulo; Simões, Maria JoãoInvasive meningococcal disease (IMD) continues to be a public health problem due to its epidemic potential, affecting mostly children. We aimed to present a detailed description of the epidemiology of IMD in Portugal, including insights into the genetic diversity of Neisseria meningitidis strains. Epidemiological analysis included data from the Portuguese National Reference Laboratory of Neisseria meningitidis during 2003 to 2020. Since 2012, N. meningitidis isolates have also been assessed for their susceptibility to antibiotics and were characterized by whole genome sequencing. During 2003–2020, 1392 confirmed cases of IMD were analyzed. A decrease in the annual incidence rate was observed, ranging from 1.99 (2003) to 0.39 (2020), with an average case fatality rate of 7.1%. Serogroup B was the most frequent (69.7%), followed by serogroups C (9.7%), Y (5.7%), and W (2.6%). Genomic characterization of 329 isolates identified 20 clonal complexes (cc), with the most prevalent belonging to serogroup B cc41/44 (26.3%) and cc213 (16.3%). Isolates belonging to cc11 were predominantly from serogroups W (77.3%) and C (76.5%), whereas cc23 was dominant from serogroup Y (65.7%). Over the past 4 years (2017–2020), we observed an increasing trend of cases assigned to cc213, cc32, and cc11. Regarding antimicrobial susceptibility, all isolates were susceptible to ceftriaxone and 61.8% were penicillin-nonsusceptible, whereas 1.4% and 1.0% were resistant to ciprofloxacin and rifampicin. This is the first detailed study on the epidemiology and genomics of invasive N. meningitidis infections in Portugal, providing relevant data to public health policy makers for a more effective control of this disease.
- Incorrect DNA methylation of the DAZL promoter CpG island associates with defective human spermPublication . Navarro-Costa, Paulo; Nogueira, Paulo; Carvalho, Marta; Leal, Fernanda; Cordeiro, Inês; Calhaz-Jorge, Carlos; Gonçalves, João; Plancha, Carlos E.Background: Successful gametogenesis requires the establishment of an appropriate epigenetic state in developing germ cells. Nevertheless, an association between abnormal spermatogenesis and epigenetic disturbances in germline-specific genes remains to be demonstrated. Methods: In this study, the DNA methylation pattern of the promoter CpG island (CGI) of two germline regulator genes—DAZL and DAZ, was characterized by bisulphite genomic sequencing in quality-fractioned ejaculated sperm populations from normozoospermic (NZ) and oligoasthenoteratozoospermic (OAT) men. Results: OAT patients display increased methylation defects in the DAZL promoter CGI when compared with NZ controls. Such differences are recorded when analyzing sperm fractions enriched either in normal or defective germ cells (P , 0.001 in both cases). Significant differences in DNA methylation profiles are also observable when comparing the qualitatively distinct germ cell fractions inside the NZ and OAT groups (P ¼ 0.003 and P ¼ 0.007, respectively). Contrastingly, the unmethylation pattern of the DAZ promoter CGI remains correctly established in all experimental groups. Conclusions: An association between disrupted DNA methylation of a key spermatogenesis gene and abnormal human sperm is described here for the first time. These results suggest that incorrect epigenetic marks in germline genes may be correlated with male gametogenic defects.
- Mortality in Portugal associated with the heat wave of August 2003: early estimation of effect, using a rapid methodPublication . Nogueira, Paulo; Marinho Falcão, José; Contreiras, Maria Teresa; Paixão, Eleonora; Brandão, João; Batista, InêsDuring the first two weeks of August 2003, Portugal was affected by a severe heat wave. Following the identification in Portugal of the influence of heat waves on mortality in 1981 and 1991 (estimated excess of about 1900 and 1000 deaths respectively), the Observatório Nacional de Saúde (ONSA) - Instituto Nacional de Saúde Dr. Ricardo Jorge, together with the Vigilância Previsão e Informação - Instituto de Meteorologia, created a surveillance system called ÍCARO, which has been in operation since 1999. ÍCARO identifies heat waves with potential influence on mortality [1]. Before the end of the 2003 heat waves, ONSA had produced a preliminary estimate of its effect on mortality. The results based on daily number of deaths from 1 June to 12 August 2003 were presented within 4 working days. Data was gathered from 31 National Civil registrars, covering the district capitals of all 18 districts of mainland Portugal, and representing approximately 40% of the mainland’s mortality. The number of deaths registered in the period 30 July to 12 August was compared with the ones registered during 3 comparison periods (of 2003): 1-14 July, 1-28 July, and 15-28 July. 15-28 July, the period best resembling the heat waves in time and characteristics, produced an estimation of 37.7% higher mortality rate then the value expected under normal temperature conditions. From this value, an estimate of 1316 death excess was obtained for mainland Portugal. The main purpose of this article is to present the method used to identify and assess the occurrence of an effect (excess mortality) during the heat waves of summer 2003
- Perceptions of Fall Prevention and Engagement in Social Prescribing Activities Among Older Adults: A Cross-Sectional Study in PortugalPublication . Matos, Cristiano; Baixinho, Cristina Rosa; Alarcão, Violeta; Henriques, Maria Adriana; Ferreira, Ricardo Oliveira; Nascimento, Tiago; Arriaga, Miguel; JORGE SILVA ALVES, TATIANA DANIELA; Nogueira, Paulo; Costa, AndreiaBackground: Falls are a major cause of injury, functional decline, and reduced quality of life among older adults, posing a significant public health challenge. Social prescribing is gaining relevance in gerontology, offering structured strategies to engage individuals in preventive activities, including fall prevention strategies, through engagement in community-based activities. Aim: To examine older adults' perception of the relevance of personal protection and development activities (e.g., prevention against falling) and compare sociodemographic, behavioural, and engagement profiles between those who agree and those who disagree with its relevance. Methods: A cross-sectional study was conducted with 613 older adults aged 65-93 years. Data collection included sociodemographic, health-related, and behavioural/social engagement variables (including perceptions regarding the benefits of social prescribing and interest in community-based activities). For this analysis, participants were dichotomized based on their agreement with the relevance of personal protection and development activities (e.g., prevention against falling). Of the 569 participants included, 538 (94.5%) agreed with its relevance and 31 (5.5%) disagreed. Descriptive and exploratory analyses were conducted to compare the two groups across variables. Multivariate logistic regression analyses were conducted to explore independent predictors of agreement across sociodemographic, behavioural, social prescribing, and health-related variables. Results: Significant differences were observed between the groups in awareness of active ageing (p = 0.018), volunteering (p < 0.001), participation in social and community activities (p < 0.001), and hobbies like gardening, fishing, or cooking (p = 0.002). Those who agreed with the importance of personal protection and development activities were significantly more likely to value a range of initiatives, including social activities in recreational organizations, physical activity in the community (e.g., hiking), artistic and creative activities (e.g., visual arts, music), technical or technological activities (e.g., do-it-yourself, computers), and cultural enrichment activities (e.g., visiting museums), (p < 0.001). Multivariate analyses showed no effects of sociodemographic or health-related factors, whereas behavioural and engagement-related variables-including volunteering, hobbies, and several social prescribing activities-significantly predicted agreement with the relevance of personal protection and development activities. Discussion: The findings suggest that older adults who perceive fall prevention as relevant are more actively engaged in diverse health-promoting activities, including volunteering, hobbies, and community-based programmes. This pattern may reflect higher health literacy, stronger social networks, and proactive attitudes towards ageing. Conclusions: Perceptions of fall prevention are closely linked to broader patterns of engagement in health-promoting activities among older adults. Recognizing and addressing differences in how these activities are valued can inform more inclusive and targeted gerontological interventions.
- Prevalence and incidence of Helicobacter pylori Infection in a healthy pediatric population in the Lisbon areaPublication . Oleastro, Mónica; Pelerito, Ana; Nogueira, Paulo; Benoliel, João; Santos, Andrea; Cabral, José; Lopes, Ana Isabel; Ramalho, Paulo; Monteiro, LurdesBACKGROUND: Helicobacter pylori is mainly acquired in childhood. Although adult studies reported a high prevalence of H. pylori infection in Portugal, the actual rate in children remains unknown. This study aimed to determine the prevalence and the incidence of H. pylori infection in an asymptomatic pediatric population of the Lisbon area and to correlate prevalence with sociodemographic determinants. MATERIALS AND METHODS: Helicobacter pylori infection was determined by stool antigen test in 844 asymptomatic children (age 0-15 years; 49.4% boys). For the incidence study, H. pylori-negative children in the prevalence study were followed-up every 6 months over a 3-year period. RESULTS: The global prevalence of H. pylori infection was 31.6%, increasing with age (19.9, 37.0 and 51.5%, in age groups 0-5, 6-10, and 11-15, respectively), but was similar among genders (34.5% in boys and 28.4% in girls). Older age and attendance of nursery/kindergarten during preschool constituted independent risk factors. The overall estimated incidence was 11.6 per 100 child-years (CY). Although 47.5% of children acquired H. pylori infection before 5 years of age, the mean age of acquisition was 6.3. The incidence of infection was similar among the three age groups (11.5, 13.0, and 10.5 per 100 CY, in age groups 0-5, 6-10, and 11-15, respectively). CONCLUSIONS: The prevalence of H. pylori infection in the Portuguese pediatric population is still high. Although this study confirmed that the highest acquisition rate occurs at young age, it showed that in high-prevalence populations, older children can also acquire H. pylori infection at a rate similar to that of young children.
- SELDI-TOF biomarker signatures for cystic fibrosis, asthma and chronic obstructive pulmonary diseasePublication . Gomes-Alves, Patrícia; Imrie, Margaret; Gray, Robert D.; Nogueira, Paulo; Ciordia, Sergio; Pacheco, Paula; Azevedo, Pilar; Lopes, Carlos; De Almeida, António Bugalho; Guardiano, Micaela; Porteous, David J.; Albard, Juan P.; Boyd, A. Christopher; Penque, DeborahOBJECTIVES: The aim of this work was to establish protein profiles in serum and nasal epithelial cells of cystic fibrosis individuals in comparison with controls, asthma and chronic obstructive pulmonary disease patients for specific biomarker signatures identification. DESIGN AND METHODS: Protein extracts were analyzed by Surface Enhanced Laser Desorption/Ionization Time-Of-Flight Mass-Spectrometry (SELDI-TOF-MS). RESULTS: The mass spectra revealed a set of peaks with differential expression in serum and nasal cells among the different groups studied, resulting into peak signatures representative/specific of each pathology. Logistic regressions were applied to those peaks; sensitivity, specificity, Youden's indexes and area under the curve (AUC) of the respective receiver operating characteristic (ROC) curves were compared. DISCUSSION: Multivariate analysis demonstrated that combination of peaks has a better predictive value than the individual ones. These protein signatures may serve as diagnostic/prognostic markers for the studied diseases with common clinical features, or as follow-up assessment markers of therapeutic interventions.