Showing papers by "Ana Azevedo published in 2014"
TL;DR: The present review highlights the potential relation between breast cancer treatments and sleep disturbances, particularly of chemotherapy, though more robust evidence is needed for a proper understanding of these associations.
93 citations
TL;DR: The substantial decreases in CVD mortality over the last decades have overcome the impact of the growth and ageing of populations in the overall number of deaths, while stabilization in the number of cancer deaths was observed only in some of the high-income countries.
Abstract: BackgroundCardiovascular diseases (CVD) and cancer are worldwide main causes of death with mortality trends varying across countries with different levels of economic development.Design and methodsWe analysed trends in CVD and cancer mortality for 37 European countries, five high-income non-European countries and four leading emerging economies (BRICS) using data from the World Health Organization database for the period 1980–2010.ResultsIn high-income countries, CVD mortality trends are characterized by steep declines over the last decades, while a downward trend in cancer mortality started more recently and was less pronounced. This resulted in the gradual convergence of the CVD and cancer mortality rates, and the latter are already higher in some countries. The absolute number of CVD deaths decreased in most settings, while cancer deaths increased in nearly all countries. Among the BRICS, China and South Africa share a similar pattern of no meaningful variation in both CVD and cancer age-standardized m...
46 citations
TL;DR: Patients can adhere differently to medication used in HF treatment, with lowest adherence to loop diuretic and beta blockers and highest adherence to ACEI.
Abstract: BACKGROUND: Adherence to medication is crucial to improve clinical outcomes in patients with heart failure (HF). However, at least 1 out of 4 patients is nonadherent to his or her medication. Several studies have quantified medication adherence in HF patients, monitoring only 1 drug with the Medication Event Monitoring System (MEMS). Some authors have argued that monitoring 1 drug reflects the whole adherence behavior, although there is some evidence of important differences in adherence to distinct drug classes. Furthermore, medication characteristics could be a relevant predictor of adherence, and different drugs could pose different barriers to patients. OBJECTIVES: To (a) quantify medication adherence to angiotensin-converting enzyme inhibitors (ACEI), beta blockers, and loop diuretics and (b) compare the agreement in adherence among drug classes in chronic HF. METHODS: Medication adherence to 3 different drugs was monitored using MEMS in 63 patients (81% male, mean age 63.5 years). Medication adheren...
44 citations
TL;DR: Higher BMI and central obesity were important potential determinants of nonneutral posture among adults from the general population and future research should investigate the potential effectiveness of overweight prevention and management in avoiding sagittal misalignment conditions.
43 citations
TL;DR: Sagittal standing posture was not consistently associated with quality of life measures in males and increased pelvic incidence and sacral slope may be involved in causing severe back pain among females.
Abstract: STUDY DESIGN A prospective radiographical study of sagittal standing posture among adults consecutively recruited from the general population. OBJECTIVE To analyze the relation of suboptimal sagittal standing posture with back pain and health-related quality of life in general adult males and females. SUMMARY OF BACKGROUND DATA Clinical studies have shown the association of sagittal standing posture with pain and reduced quality of life, but this relation has not been assessed in the general adult population. METHODS As part of the EPIPorto population-based study of adults, 178 males and 311 females were evaluated. Age, education, and body mass index were recorded. Radiographical data collection consisted of 36-in. standing sagittal radiographs. Creation of 3 groups for individual spinopelvic parameters was performed (low, intermediate, or high), and 1 of 4 sagittal types of postural patterns attributed to each participant (Roussouly classification). Back pain prevalence and severity were assessed on the basis of self-reported data and health-related quality of life using 2 main components of the 36-Item Short Form Health Survey. RESULTS In males, differences in back pain severity were observed only among pelvic tilt/pelvic incidence ratio groups. Females presenting high pelvic incidence and sacral slope exhibited higher odds of severe back pain than those with intermediate values (adjusted odds ratios = 2.21 and 2.15; 95% confidence interval, 1.24-3.97 and 1.21-3.86; respectively). Sagittal vertical axis showed the largest differences in physical quality of life of females: high group had 8.8 lower score than the low group (P < 0.001), but this result lost statistical significance after adjustment for age, education, and body mass index. CONCLUSION Sagittal standing posture was not consistently associated with quality of life measures in males. Increased pelvic incidence and sacral slope may be involved in causing severe back pain among females. Monitoring sagittal postural parameters has limited usefulness as a screening tool for causes of unspecific musculoskeletal symptoms in the general adult population. LEVEL OF EVIDENCE 3.
41 citations
TL;DR: Lower handgrip strength at hospital admission was associated with a longer time in the hospital, in patients of both sexes, in medical and surgical wards, and its direction remained unchanged regardless of the aforementioned factors.
Abstract: Background and Objective: Handgrip strength is a relevant marker of functional status and is also a component of nutrition assessment. The simplicity of this measurement supports its usefulness as a tool to predict who will likely take longer to hospital discharge. The aim of this study was to quantify the association between sex-specific handgrip strength at hospital admission and time to discharge alive. We intended to include a group of diverse diagnoses and to compare medical and surgical wards, taking into account the potential confounders’ effect of patients’ characteristics and severity of disease. Subjects and Methods: Prospective study in 2 public acute-care general hospitals in Porto, Portugal, in 2004. Handgrip strength was evaluated using a handgrip dynamometer in a probability sample of 425 patients from medical and surgical wards. The association between baseline handgrip strength and time to discharge was evaluated using survival analysis with discharge alive as the outcome and deaths and t...
36 citations
TL;DR: The vast majority of younger patients were discharged on evidence-based secondary preventive medications, but only half received the 5-drug combination, and recommended therapies were substantially underprescribed in older patients.
Abstract: Aim: To assess the proportion of patients receiving pharmacological therapy for secondary prevention after an acute coronary syndrome (ACS) in Portugal and to identify age and sex inequalities. Design: Retrospective cohort study. Methods: We studied 747 episodes of ST-segment elevation myocardial infarction (STEMI) and 1364 of non-ST-segment elevation ACS (NSTE-ACS), within a sample of ACS cases consecutively discharged from 10 Portuguese hospitals, in 2008-2009. We estimated adjusted odds ratios (OR) for the association of age and sex with the use of each pharma- cological treatment. Results: In STEMI and NSTE-ACS patients, the proportion of patients discharged with aspirin was 96 and 88%, clopidogrel 91 and 78%, aspirinþclopidogrel 88 and 71%, beta-blockers 80 and 76%, angiotensin-converting enzyme (ACE) inhibitors/ARB 82 and 80%, statins 93 and 90%, 3-drug (aspirin/clopidogrelþbeta-blockerþstatin) 76 and 69%, and 5-drug treatment (aspirinþclopidogrelþbeta-blockerþACE inhibitor/ARBþstatin) 61 and 48%, respectively. Among STEMI patients, those aged � 80 years were substantially less often discharged with clopidogrel (OR 0.22, 95% confidence interval, CI, 0.08-0.56), aspirinþclopidogrel (OR 0.34, 95% CI 0.15-0.76), beta-blockers (OR 0.39, 95% CI 0.18-0.82), 3-drug (OR 0.41, 95% CI 0.21-0.83), and 5-drug treatments (OR 0.44, 95% CI 0.23-0.83) than those <60 years; women were less likely to be discharged with aspirinþclopidogrel (OR 0.52, 95% CI 0.29-0.91). Among NSTE-ACS patients, those aged � 80 years were much less likely to be discharged with beta-blockers (OR 0.58, 95% CI 0.36-0.93), statins (OR 0.35, 95% CI 0.19-0.64), and 3-drug treatment (OR 0.47, 95% CI 0.30-0.75); sex had no significant effect on treatment prescription. Conclusions: The vast majority of younger patients were discharged on evidence-based secondary preventive medi- cations, but only half received the 5-drug combination. Recommended therapies were substantially underprescribed in older patients.
27 citations
TL;DR: The Portuguese version of METER, a brief and simple instrument for health literacy assessment, was culturally adapted and validated, and showed it was valid and reliable.
26 citations
TL;DR: Sudden declines in the minimum temperatures were associated with a higher incidence of stroke hospitalizations in Maputo, Mozambique, providing important information for prediction of periods of higher hospital affluence because of stroke and to understand the mechanisms underlying the triggering of a stroke event.
Abstract: Background Identifying locale-specific patterns regarding the variation in stroke incidence throughout the year and with atmospheric temperature may be useful to the organization of stroke care, especially in low-resource settings. Goal We aimed to describe the variation in the incidence of stroke hospitalizations across seasons and with short-term temperature variation, in Maputo, Mozambique. Methods Between August 1, 2005, and July 31, 2006, we identified 651 stroke events in Maputo dwellers, according to the World Health Organization’s STEPwise approach. The day of symptom onset was defined as the index date. We computed crude and adjusted (humidity, precipitation and temperature) incidence rate ratios (IRRs) and 95% confidence intervals (CIs) with Poisson regression. Results Stroke incidence did not vary significantly with season (dry versus wet: crude IRR = .98, 95% CI: .84-1.15), atmospheric temperature at the index date, or average atmospheric temperature in the preceding 2 weeks. The incidence rates of stroke were approximately 30% higher when in the previous 10 days there was a decline in the minimum temperature greater than or equal to 3°C between any 2 consecutive days (variation in minimum temperature −5.1 to −3.0 versus −2.3 to −.4, adjusted IRR = 1.31, 95% CI: 1.09-1.57). No significant associations were observed according to the variation in maximum temperatures. Conclusions Sudden declines in the minimum temperatures were associated with a higher incidence of stroke hospitalizations in Maputo. This provides important information for prediction of periods of higher hospital affluence because of stroke and to understand the mechanisms underlying the triggering of a stroke event.
22 citations
TL;DR: Fluorescence in situ hybridization was used to analyze the chromosome status of zygotes with a single pronucleus from in vitro fertilization and intracytoplasmic sperm injection treatment cycles, suggesting premature pronuclear breakdown and suggesting monopronucleated zygote should not be used in assisted reproductive treatments.
Abstract: The aim of the present study was to use fluorescence in situ hybridization to analyze the chromosome status of zygotes with a single pronucleus from in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment cycles. In addition, we performed immunocytochemical detection of nuclear lamins and histone H3 trimethylated at lysine-9, Me(3)H3K9. Zygotes were processed 24 hours after insemination or injection to assure the absence of asynchrony. In opposition to previous results, we observed 2 pronuclei in 16 of 18 IVF zygotes and 40 of 64 ICSI zygotes, suggesting premature pronuclear breakdown. In IVF and ICSI zygotes, the rate of normal diploidy was only 6 of 16 and 27 of 56, respectively, suggesting that monopronucleated zygotes should not be used in assisted reproductive treatments. The possible mechanisms are discussed and compared to previous studies of monopronucleated zygotes.
22 citations
TL;DR: The prevalence of self-reported diabetes and mean fasting glucose increased in the last two decades, demanding for effective strategies to reverse this tendency and to manage the increasing number of people with diabetes in the Portuguese population.
TL;DR: In conclusion, worsening renal function was significantly associated with a worse outcome and different definitions identified different patients at risk and increasing creatinine/urea performed better than decreasing estimated glomerular filtration rate.
TL;DR: This study yielded a new framework for the description, interpretation and prediction of IHD mortality trends worldwide, similar for men and women in the last three decades.
TL;DR: The quality of information on acute myocardial infarction/ stroke in Portuguese websites was acceptable, although often incomplete and trustworthiness was low, impairing users' capability of identifying potentially more reliable content.
Abstract: Introduction: The quality of health information in the Internet may be low This is a concerning issue in cardiovascular diseases which warrant patient self-management We aimed to assess the quality of Portuguese websites as a source of health information on acute myocardial infarction and stroke Material and Methods: We used the search terms ‘enfarte miocardio’ and ‘acidente vascular cerebral’ (Portuguese terms for myocardial infarction and stroke) on Google®, on April 5th and 7th 2011, respectively, using Internet Explorer® The first 200 URL retrieved in each search were independently visited and Portuguese websites in Portuguese language were selected We analysed and classified 121 websites for structural characteristics, information coverage and accuracy of the web pages with items defined a priori, trustworthiness in general according to the Health on the Net Foundation and regarding treatments using the DISCERN instrument (48 websites) Results: Websites were most frequently commercial (495%), not exclusively dedicated to acute myocardial infarction/ stroke (942%), and with information on medical facts (595%), using images, video or animation (603%) Websites’ trustworthiness was low None of the websites displayed the Health on the Net Foundation seal Acute myocardial infarction/ stroke websites differed in information coverage but the accuracy of the information was acceptable, although often incomplete Conclusion: The quality of information on acute myocardial infarction/ stroke in Portuguese websites was acceptable Trustworthiness was low, impairing users’ capability of identifying potentially more reliable content
TL;DR: Seasonal pattern of incidence and case fatality of acute myocardial infarction in a Japanese population (From the Takashima AMI Registry, 1988-2003) is revealed.
Abstract: 3. Turin TC, Kita Y, Murakami Y, et al. Higher stroke incidence in the spring season regardless of conventional risk factors: Takashima Stroke Registry, Japan: 19882001. Stroke 2008;39:745-752. 4. Hong YC, Rha JH, Lee JT, et al. Ischemic stroke associated with decrease in temperature. Epidemiology 2003;14: 473-478. 5. Dawson J, Weir C, Wright F, et al. Associations between meteorological variables and acute stroke hospital admission in the west of Scotland. Acta Neurol Scand 2008; 117:85-89. 6. Li X, Zhang JH, Qin X. Intracerebral hemorrhage and meteorological factors in Chongqing, in the southwest of China. Acta Neurochir Suppl 2011;111:321-325. 7. Rumana N, Kita Y, Turin TC, et al. Seasonal pattern of incidence and case fatality of acute myocardial infarction in a Japanese population (From the Takashima AMI Registry, 1988-2003). Am J Cardiol 2008;102:1307-1311. 8. Turin TC, Kita Y, Rumana N, et al. Increased risk of acute myocardial infarction during colder periods is independent of the conventional cardiovascular risk factors. Takashima AMI Registry, Japan. CVD Prev Control 2011;6:109-111. 9. Barnett AG, de Looper M, Farser JF. The seasonality in heart failure deaths and total cardiovascular deaths. Aust N Z J Public Health 2008;32:408-413. 10. Tofler GH, Muller JE. Triggering of acute cardiovascular disease and potential preventive strategies. Circulation 2006;114:1863-1872. 11. McArthur K, Dawson J, Walters M. What is it with the weather and stroke? Exp Rev Neurother 2010;10: 243-249.
TL;DR: The general pattern of the use of reperfusion and revascularization for the treatment of acute coronary syndrome patients over time in Portugal is in accordance with that reported in other developed countries, reflecting a favorable trend in the quality of care of ACS patients.
Abstract: Introduction and Objectives: Reperfusion and revascularization therapies play an important role in the management of coronary heart disease and have contributed to decreases in case fatality rates. We aimed to describe the use of these therapies for the treatment of acute coronary syndrome (ACS) patients over time in Portugal. Methods: PubMed was searched in July 2012. The proportion of patients treated with fibrinolysis, primary percutaneous coronary intervention (PCI), any PCI and coronary artery bypass grafting (CABG) was described according to type of ACS: STEMI (≥90% patients with ST-segment elevation or Q-wave myocardial infarction), NSTE-ACS (≥90% patients with non-STsegment elevation ACS) and mixed ACS (all others). Results: We identified 41 eligible studies, published between 1989 and 2011. Twenty-eight reported on samples considered representative of ACS patients treated in Portugal. The small number of estimates of the use of each treatment in STEMI and NSTE-ACS patients precluded identification of any time trend. In the last 20 years, the proportion of mixed ACS patients treated with fibrinolysis decreased and the use of PCI increased, while the use of CABG did not change. Conclusions: The general pattern of the use of reperfusion and revascularization is in accordance with that reported in other developed countries, reflecting a favorable trend in the quality of care of ACS patients. The relatively small number of estimates on the same procedure in comparable patients limits the generalizability of the conclusions, and highlights the need for systematic approaches to monitor the use of treatments over time. © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
TL;DR: This work presents a meta-analyses of the determinants of heart attack mortality and stroke in women over a 40-year period and shows clear patterns of disease progression that are consistent with known mechanisms, namely smoking and obesity.
TL;DR: In this paper, the authors described the prevalence and main correlates of use of medicines from different Anatomical Therapeutic Chemical classification (ATC) groups among homeless adults from the city of Porto, Portugal.
Abstract: The objective of this study was to describe patterns of medication use among homeless adults from the city of Porto, Portugal. We recruited 146 homeless participants in four social services institutions. Data on the use of medicines in the previous week were collected using face-to-face interviews. We described the prevalence and main correlates of use of medicines from different Anatomical Therapeutic Chemical classification (ATC) groups. A total of 56.8% of the homeless reported to have used at least one medicine in the previous week. The most frequently reported were benzodiazepines (21.9%) and antipsychotics (15.1%); socio-demographic characteristics, lifestyle variables and use of health care were not found to be significantly associated with their use. The prevalence was 1.4% for anti-inflammatory and antirheumatic products, and 6.2% for antihypertensives, diuretics and beta-blocking agents. Medicines pertaining to the nervous system ATC group were by far the most frequently used, while those for the treatment of other common chronic and acute conditions seem to be underused.