Browsing by Issue Date, starting with "2019-07-09"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
- Vigilância de Processos na Garantia da Segurança Alimentar e da Qualidade Nutricional em Unidades HospitalaresPublication . Saraiva, Margarida; Coelho Santos, Mariana; Belo Correia, CristinaOs serviços de alimentação hospitalar têm como objetivo fornecer aos doentes/utentes, bem como a familiares/visitantes e funcionários, alimentos que atendam às necessidades nutricionais, microbiologicamente seguros e servidos em tempos convenientes e apropriados. A alimentação é uma área vital e de impacto marcante para o doente. Contribui diretamente para o seu bem-estar e melhoria da sua qualidade de vida, e indiretamente pode propiciar a redução do tempo de internamento, rentabilizando desta forma todos os recursos envolvidos. Além disso, a alimentação disponibilizada representa ainda um papel importante na vertente emocional, que não se deve sobrepor à necessidade de segurança de uma população vulnerável como a que encontramos em meio hospitalar. Segundo a Resolução ResAP (2003) do Conselho da Europa sobre alimentação e cuidados nutricionais nos hospitais, aos Estados-Membros compete a elaboração e aplicação de recomendações nacionais para os cuidados alimentares e nutricionais nos hospitais. Nesta Resolução são enunciadas cerca de 100 recomendações específicas englobadas em diferentes categorias, a serem implementadas pelos hospitais com o propósito de combater a desnutrição hospitalar e promover a recuperação dos doentes e da sua qualidade de vida. O fornecimento da alimentação em ambiente hospitalar proporciona uma oportunidade para o indivíduo adotar hábitos alimentares saudáveis. O internamento hospitalar poderá representar um momento de literacia dos princípios de alimentação saudável e segura. Para tal, é importante que haja coerência entre o aconselhamento dietético e o que realmente é fornecido pelos serviços de alimentação hospitalar. Qualquer tipo de dieta deverá ser fornecido de acordo com as características adequadas ao indivíduo em causa e com sabor e aparência agradáveis. Neste âmbito, considera-se que a padronização de um Manual de Dietas Hospitalares é de vital importância para a uniformização das características de cada dieta, assim como a sua adequação às necessidades nutricionais dos doentes.
- Doença Meningocócica Invasiva em Portugal: vigilância epidemiológica (2003 a 2018)Publication . Simões, Maria JoãoApresentam-se os dados da vigilância integrada da doença meningocócica em Portugal, entre 2003 a 2018: incidência por grupo etário e por serogrupo, evolução genética de estirpes invasivas circulantes e problemas emergentes.
- Surveillance of invasive meningococcal disease in Portugal, 2016-2018Publication . Bettencourt, Célia; Martins, João Vieira; Ramos, Marina; Machado, Rita Sá; Simões, Maria JoãoIntroduction: Since October 2002 the surveillance of invasive meningococcal disease (IMD) in Portugal includes a mandatory laboratory notification in addition to the clinical notification, which had been mandatory since 1939. The Directorate-General of Health manages the epidemiological information and the interventions. Data from surveillance is therefore the basis for prevention and control policies. Vaccination against MenC started in 2002 and, in 2006, the vaccine was introduced in the national immunization programme, aimed to children under one year of age. Since 2007 the number of invasive C strains became residual. In April 2014, the multi-component vaccine 4CMenB was introduced in the market. The aim of this study is to perform a descriptive analysis of laboratory-based surveillance of IMD from 2016 to 2018 (data from 2018 are preliminary). Methods: The case definition of IMD is in accordance with ECDC guidelines. Hospital laboratories send meningococcal isolates to the reference laboratory for genotyping, as well as negative culture clinical samples from suspected cases for lab confirmation and genotyping. Probable and possible cases were confirmed by real time PCR targeting ctrA and sodC. Groups were identified by PCR; porA, FetA and MLST characterization was performed through amplicon-based Sanger sequencing (clinical samples) or WGS (isolates). Results: In the 3-year period, 154 cases of IMD were reported (150 confirmed and 4 possible/probable). The incidence rate ranged from 0.41 cases per 100,000 inhabitants in 2016 to 0.47 in 2017 and 0.58 in 2018. Group B was the most frequent (76.2% in 2016, 62.5% in 2017 and 70.0% in 2018), presenting a large genetic diversity. The most common subtypes within B strains were P1.7-2,4, mostly belonging to cc162 and cc41/44, and P1.22,14 (13.3%), almost all belonging to cc213. Serogroup Y was the second most frequent (14.3% in 2016, 8.3% in 2017 and 10.0% in 2018), mostly belonging to cc23. Serogroups W and C represented 5.3% and 4.7%, respectively, of all invasive strains from the 3-year period. None of the patients with IMD due to MenC was vaccinated. One serogroup Z strain was identified in 2017. Conclusions: The incidence rate of IMD in Portugal has been low in the 3-year period from 2016 to 2018, under the average of incidence rate in the European countries (0.63-0.62 per 100,000 people). Group B has been the most frequent, mostly belonging to cc41/44 and cc213. It is important to continue the IMD surveillance in order to evaluate the need of policies regarding current vaccines.
- HBM4EU - Deliverable Report D 5.5: Human biomonitoring in risk assessment: 2nd set of examples on the use of HBM in risk assessments of HBM4EU priority chemicalsPublication . Santonen, Tiina; Mahiout, Selma; Bessems, J.; Buekers, J.; Baken, K.; Schoeters, G.; Woutersen, M.; Vermeire, T.; Bil, W.; Ougier, E.; Rousselle, C.; Šömen Joksić, A.; Kirinčič, S.; Louro, Henriqueta; Silva, Maria João; Assunção, Ricardo; Vinggaard, A. M.; Viegas, S.; Huuskonen, P.; Porras, S.; Kiilunen, M.; Uhl, M.; Hartmann, C.; Hauzenberger, I.; Losert, A.; Tratnik, J. Snoj; Horvat, M.; Schaddelee-Scholten, B.; Buist, H.; Westerhout, J.; Fletcher, T.; Rauscher-Gabernig, E.; Plichta, V.; Abraham, K.; Borges, T.; Kadikis, N.The aim of this work was to exemplify the inclusion of human biomonitoring (HBM) data in risk assessment (RA) and health impact assessment (HIA) strategies. RA was performed for six compound groups on HBM4EU’s first list of priority substances: anilines, cadmium/chromium, flame retardants, PAHs, PFAS and phthalates. In addition, burden of disease (BoD) calculations were made for cadmium. The general approach used included: 1) identification of an existing RA for the substance, 2) identification of possible existing biological limit or guidance values or biological equivalents (BEs), or if lacking, existing health based limit values for external exposure, 3) identification of relevant biomonitoring data to be used in the RA, 4) in case no existing biological limit or guidance values or BEs existed, identification of approaches for reverse/forward calculation, including the use of PBPK modelling or calculation of BE values based on one-compartment modelling, 5) RA or BoD calculation based on HBM data, 6) analysing the benefits and challenges of using HBM data in RA compared to the use of external exposure data. The overall result of the work was that HBM can be included in RA even when relatively few data are available, and its inclusion generally benefits the RA. Several methods exist, and a tiered approach is suggested, based on the amount and quality of data available. The recommended 1st tier method is a one-compartment modelling based derivation of BE values or reverse calculation of external exposure based on biomarker levels. This approach is simple and rough, and uses only very basic parameters. However, in many cases this approach can be considered sufficient, especially when conservative assumptions have been used for the FUE, and the calculated RCRs remain well below 1, indicating a low risk. Also, in cases in which risk assessment using this approach supports the RA made based on external exposure estimates, it is often a sufficient approach. Nevertheless, in some cases e.g. where the RCR is close to 1, a more detailed approach may be needed to refine the RA. For the 2nd tier, PBPK modelling is recommended. For the most robust, 3rd tier approach, measured data on correlations between external exposure and internal doses from well controlled studies would be needed. Certain cases were identified where inclusion of HBM would be particularly important for performing RA: for compounds, for which several exposure routes may contribute to the body burden and the health effects, as HBM reflects the total body burden, and cumulative compounds. For cumulative compounds, HBM could also be useful for hazard assessment in addition to exposure assessment. One of the major challenges for the inclusion of HBM into RA is the often limited data available on toxicokinetics. In addition, in some cases, there is an urgent need for more specific biomarkers or more sensitive analytic methods than currently available. It should be noted that these risk assessments were performed purely to determine how HBM data can contribute to the risk assessment of chemicals, and they have no regulatory implications. Overall for the substances on the HBM4EU’s first list of priority substances, more HBM data are needed. This work is ongoing in WP8, and the RAs presented here will be updated when new data become available.