CD - Artigos em revistas internacionais
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- Are physicians aware of their role in tobacco control? A conference-based survey in PortugalPublication . Ravara, Sofia B.; Castelo-Branco, Miguel; Aguiar, Pedro; Calheiros, José M.BACKGROUND: The crucial role of physicians in tobacco control (TC) is widely recognized. In 2008, Portugal implemented a non-comprehensive smoke-free policy (SFP). In 2009, a conference-survey was carried out to explore Portuguese physicians' engagement in tobacco control, by evaluating the following: 1) attendance at TC training and awareness of training needs; 2) participation in TC activities; 3) attitudes and beliefs regarding SFPs. METHODS: Questionnaire-based cross-sectional study conducted during two major national medical conferences targeting GPs, hospitalists, and students/recent graduates. Descriptive analysis and logistic regression were performed. RESULTS: Response rate was 63.7% (605/950). Of the 605 participants, 58.3% were GPs, 32.4% hospitalists, 9.3% others; 62.6% were female; mean age was 39.0 ± 12.9 years. Smoking prevalence was 29.2% (95% CI: 23.3-35.1) in males; 15.8% (95% CI: 12.1-19.5) in females, p < 0.001. While the overwhelming majority of physicians strongly agreed that second-hand smoke (SHS) endangers health, awareness of SFP benefits and TC law was limited, p < 0.001. A significant minority (35.5%) believed that SHS can be eliminated by ventilation systems. Most physicians lacked training; only a minority (9.0%) participated regularly in TC. Training was the most consistent predictor of participation in TC. General agreement with SFP was high; but significantly lower for indoor leisure settings, outdoors bans in healthcare/schools settings and smoking restrictions in the home/car, p < 0.001. Smoking behaviour strongly predicted support for smoking restrictions in restaurants and bars/discos, healthcare outdoors and private settings. CONCLUSIONS: The findings suggest that Portuguese physicians are not aware of their role in tobacco control. Poor engagement of physicians in TC may contribute to the current lack of comprehensive policies in Portugal and Europe and undermine social norm change. Medical and professional continuing education on tobacco control should be made top priorities.
- Clinical standards for antimicrobial stewardship in TB carePublication . Brehm, T T; Akkerman, O W; Sotgiu, G; Tiberi, S; Chang, K-C; Dheda, K; Duarte, Raquel; Vambe, D; Udwadia, Z F; Chesov, D; Mendelson, M; Iswari Saktiawati, A M; van Ingen, J; Eyuboglu, F O; Tängdén, T; Quang Vo, L N; Riccardi, N; Moschos, C; Friedland, J S; Lillebaek, T; Chandy, S J; Caminero, J A; Thwaites, G; Gandra, S; Thursky, K; George, I A; Konstantynovska, O; Fatima, R; Yim, J-J; Kwak, N; Olaru, I D; Gillespie, S H; Kherabi, Y; Perl, S H; Grønningen, E; Rodrigues, C; Bjerrum, S; Bange, F; Cox, V; Cirillo, D M; Saluzzo, F; Hara, G L; Wagner, D; Ismail, N; Sloan, D J; Eshun-Wilsonova, I; Zeng, M; Cantero, C; Vasankari, T; Mandalakas, A; Kay, A; Ness, T; Torrico, M M; Günther, G; Kuksa, L; Guglielmetti, L; García-Basteiro, A L; Marks, G B; Pulcini, C; Lange, CBackground: While antimicrobial stewardship (AMS) is essential for combating antimicrobial resistance (AMR), TB-specific AMS strategies remain poorly defined. Methods: An international panel of 62 experts participated in a Delphi process. Using a 5-point Likert scale (5 = strong agreement; 1 = strong disagreement), participants evaluated 10 draft clinical standards developed by a core coordination team. A standard was adopted if ≥90% of respondents rated it three or higher, according to a predefined consensus threshold. Results: All 10 standards reached the consensus threshold and were adopted: Standard 1, integration of TB into national AMR action plans; Standard 2, implementation of TB surveillance systems; Standard 3, education of health care providers, individuals affected by TB, and the public; Standard 4, integration of TB into AMS activities; Standard 5, establishment of expert consultation services; Standard 6, targeted testing and preventive treatment for individuals at risk for TB; Standard 7, access to timely and comprehensive drug susceptibility testing; Standard 8, prioritisation of efficacy, safety, and resistance prevention in TB treatment regimens; Standard 9, clinical and microbiological monitoring of treatment response; and Standard 10, assessment of adherence, drug exposure, and resistance in treatment failure. Conclusion: These clinical standards aim to support clinicians, programme managers, and public health authorities in implementing effective, TB-specific AMS strategies.
- Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional studyPublication . Ravara, Sofia B.; Castelo-Branco, Miguel; Aguiar, Pedro; Calheiros, José M.BACKGROUND: Research evaluating enforcement and compliance with smoking partial bans is rather scarce, especially in countries with relative weak tobacco control policies, such as Portugal. There is also scarce evidence on specific high risk groups such as vehicle workers. In January 2008, Portugal implemented a partial ban, followed by poor enforcement. The purpose of this study was to explore the effectiveness of a partial smoking ban in a pro-smoking environment, specifically transportation by taxi in the city of Lisbon. Ban effectiveness was generally defined by ban awareness and support, compliance and enforcement. METHODS: Exploratory cross-sectional study; purposive sampling in selected Lisbon streets. Structured interviews were conducted by trained researchers while using taxi services (January 2009-December 2010). Participants: 250 taxi drivers (98.8% participation rate). Chi-square, McNemar, Man Whitney tests and multiple logistic regression were performed. RESULTS: Of the participants, 249 were male; median age was 53.0 years; 43.6% were current smokers. Most participants (82.8%) approved comprehensive bans; 84.8% reported that clients still asked to smoke in their taxis; 16.8% allowed clients to smoke. Prior to the ban this value was 76.9% (p < 0.001). The major reason for not allowing smoking was the legal ban and associated fines (71.2%). Of the smokers, 66.1% admitted smoking in their taxi. Stale smoke smells were detected in 37.6% of the cars. None of the taxi drivers did ever receive a fine for non-compliance. Heavy smoking, night-shift and allowing smoking prior the ban predicted non-compliance. CONCLUSIONS: Despite the strong ban support observed, high smoking prevalence and poor enforcement contribute to low compliance. The findings also suggest low compliance among night-shift and vehicle workers. This study clearly demonstrates that a partial and poorly-enforced ban is vulnerable to breaches, and highlights the need for clear and strong policies.
- Diagnostic accuracy and predictive value of the QuantiFERON-TB gold plus assay for tuberculosis in immunocompromised individuals: a prospective TBnet studyPublication . Sester, Martina; Altet-Gomez, Neus; Andersen, Åse Bengaard; Arias-Guillén, Miguel; Avsar, Korkut; Bakken Kran, Anne-Marte; Bothamley, Graham; Nordholm Breschel, Anne Christine; Brown, James; Chesov, Dumitru; Ciobanu, Nelly; Cirillo, Daniela Maria; Crudu, Valeriu; de Souza Galvao, Malu; Dilektasli, Asli Görek; Dominguez, José; Duarte, Raquel; Dyrhol-Riise, Anne Ma; Goletti, Delia; Hoffmann, Harald; Ibraim, Elmira; Kalsdorf, Barbara; Krawczyk, Marcin; Kunst, Heinke; Lange, Berit; Lipman, Marc; Matteelli, Alberto; Milkiewicz, Piotr; Neyer, David; Nitschke, Martin; Oral, Haluk Barbaros; Palacios-Gutiérrez, Juan José; Petruccioli, Elisa; Raszeja-Wyszomirska, Joanna; Ravn, Pernille; Rupp, Jan; Spohn, Hanna-Elisa; Toader, Corina; Villar-Hernandez, Raquel; Wagner, Dirk; van Leth, Frank; Martinez, Leonardo; Pedersen, Ole Skouvig; Lange, ChristophBackground: In low tuberculosis (TB)-endemic countries, tuberculosis preventive therapy (TPT) is recommended for immunocompromised individuals with a positive immunodiagnostic test. This study aimed to assess the performance of the QuantiFERON-TB Gold Plus (QFT+) assay and predictive power for future tuberculosis in immunocompromised individuals. Methods: In this prospective observational study, immunocompromised adults ≥18 years of age including people living with HIV (PLHIV), chronic renal failure, rheumatoid arthritis, solid-organ transplantation or stem-cell transplantation, and immunocompetent adults with and without TB-disease were recruited at 21 sites in 11 European countries and tested with the QFT+ assay. Individuals without TB-disease were followed up for the development of tuberculosis. TB incidence rates (IR) were calculated, stratified by QFT+ results and acceptance of TPT. This study is registered with Clinicaltrials.gov, NCT02639936. Findings: A total of 2663 individuals (1115 female, 1548 male) were enrolled from 03/11/2015 to 29/03/2019. Persons without tuberculosis were followed up for at least two years. Among 1758 immunocompromised individuals without active tuberculosis, 13.6% had positive QFT+ results. Sensitivity and specificity for TB-disease were 70.0% (52.1-83.3%) and 91.4% (89.6-92.9%), respectively, in immunocompromised, and 81.4% (76.6-85.3%) and 96.0% (92.5-97.9%), respectively, in immunocompetent individuals. During 2457 cumulative years of follow-up among 932 individuals with chronic renal failure, rheumatoid arthritis, solid-organ transplantation or stem-cell transplantation, including 83 persons with a positive QFT+ test without TPT, no-one developed active tuberculosis. In contrast, among 642 PLHIV without TPT, one with an indeterminate QFT+ and 3/30 individuals with a positive QFT+ developed active tuberculosis; all had detectable HIV-replication and low CD4 T-cell counts (incidence 4.1 (95% CI (1.3-12.4) per 100 person-years). No individuals receiving TPT developed active tuberculosis during 269 years of follow-up. Interpretation: In immunocompromised individuals in low TB-endemic countries, the 2-year-risk for active tuberculosis was highest among PLHIV with detectable HIV-replication and low CD4-counts. In this study, the QFT+ assay did not strongly predict progression to active tuberculosis, which emphasises the need to incorporate additional risk factors.
- The Empty Medicine Cabinet: Urgent Action Needed to Resolve TB Drug Shortages in EuropePublication . Goletti, D.; Cirillo, D.M.; Lange, C.; Tiberi, S.; Günther, G.; Petrone, L.; Kuksa, L.; Opota, O.; Akkerman, O.; Podlekareva, D.; Guglielmetti, L.; Duarte, R.No abstract available.
- ERS Congress 2024: highlights from the Respiratory Infections AssemblyPublication . Jonckheere, Leander; Papadopoulou, Efthymia; Piedepalumbo, Federica; Akkerman, Onno W.; Duarte, Raquel; Premuda, ChiaraExtract: The 2024 European Respiratory Society (ERS) Congress in Vienna, Austria, brought together leading experts worldwide to address some of the most pressing challenges in respiratory medicine. In the field of respiratory infections, the congress highlighted notable advancements, particularly regarding pulmonary aspergillosis, tuberculosis (TB) and cystic fibrosis (CF), reflecting the rapidly evolving landscape in this area. This article aims to provide an overview of the key highlights from the congress in the field of respiratory infections, offering insights into the latest research, treatment innovations and ongoing challenges in managing these complex respiratory diseases.
- Expert perspectives on tuberculosis screening procedures for migrantsPublication . Pinheiro, Marina; Moreira, David N.; Aguiar, Ana; Duarte, RaquelObjective: To evaluate the perspectives of tuberculosis experts from different countries regarding national screening procedures. Methods: This was a qualitative descriptive study. Data were collected by using electronic, anonymized surveys with experts in tuberculosis in seven different countries within two World Health Organization regions (Europe and Africa). Thematic analysis was employed. Results: The survey results indicate that there are varied perceptions of and experiences with national guidelines on screening for and treatment of tuberculosis (especially in the population tested), the appropriate timing of screening, types of tests, best practices, barriers, and limitations of the screening. The participants highlighted the importance of integrating health care services into the community to achieve people-centered health care. The study also sheds light on the importance of involving trained nurses and social workers in the screening process and of networks to ensure continuity of care. Conclusions: The overall perceptions of the respondents underscore the importance of standardized screening guidelines. The ongoing collaboration between public health services, the private sector, and the community is essential to reduce tuberculosis transmission, as well as to provide substantial public health and economic benefits.
- Exploring perspectives on the benefits of a tuberculosis short-treatment regimen: a cross-sectional study on treatment experiences and perceptionsPublication . Silva, Fernando Pereira da; Ramos, João Pedro; Barbosa, Pedro; Vieira, Mariana; Duarte, RaquelNo abstract available.
- Front-of-pack labelling policies and the need for guidancePublication . Goiana-da-Silva, Francisco; Cruz-e-Silva, David; Miraldo, Marisa; Calhau, Conceição; Bento, Alexandra; Cruz, Diogo; Almeida, Fernando; Darzi, Ara; Araújo, FernandoFood labels are a challenge for most consumers, and the development of easily understandable labelling is essential when it comes to empowering consumers in making healthier food choices. (...)
- The importance of getting the dose right in the treatment of tuberculosisPublication . Dudnyk, Andrii; Lutchmun, Wandini; Duarte, Raquel; Lange, Christoph; Svensson, Elin M.; on behalf of the UNITE4TB ConsortiumPrescribing the optimal combination of anti-tuberculosis drugs at the right dose is a fundamental step to achieve successful treatment outcomes. To aid the decision, clinicians should consider multiple factors, such as body weight, age, results of drug susceptibility testing, risk of intolerance and potential drug-drug interactions. In this viewpoint, we outline different aspects of dose selection in the treatment of tuberculosis (TB) such as traditional pharmacokinetics/pharmacodynamics, population pharmacokinetics models, the importance of real-world evidence and clinical trial design in the development of shorter treatment regimens and the new TB drug pipeline. Therapeutic drug monitoring for rifampicin, linezolid and amikacin may significantly improve their risk-benefit profile promoting their responsible administration. Precision dosing of novel, repurposed or conventional TB drugs should ensure optimal efficacy, while minimising toxicity and the development of resistance.
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