Browsing by Author "Alves, Sandra Maria"
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- Age-period-cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in riskPublication . Alves, Sandra Maria; Castiglione, Débora; Oliveira, Carla Maria; Sousa, Bruno; Pina, Maria De FátimaIntroduction: Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000–2008. Methods: From the National Hospital Discharge Register, we selected admissions (aged ≥49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age–period–cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. Results: There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable–increasing), 1940 (decreasing–increasing) and 1950 (increasing–decreasing only among women). Conclusions: Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.
- Empowerment and knowledge as determinants for quality of life: a contribution to a better type 2 diabetes self-managementPublication . Ferreira, Pedro L.; Morais, Carminda; Pimenta, Rui; Ribeiro, Inês; Amorim, Isabel; Alves, Sandra MariaThe purpose of this study was to assess how knowledge and empowerment impact the quality of life (QoL) of a person with type 2 diabetes, leading to better communication and disease management. We conducted a descriptive and observational study of individuals with type 2 diabetes. The Diabetes Empowerment Scale-Short Form (DES-SF), Diabetes Knowledge Test (DKT), and EQ-5D-5L were used, in addition to sociodemographic and clinical characteristics. Evaluating the variability in the DES-SF and DKT in relation to the EQ-5D-5L and identifying possible sociodemographic and clinical determinants were conducted using univariate analyses followed by a multiple linear regression model to test whether the factors significantly predicted QoL. A total of 763 individuals were included in the final sample. Patients aged 65 years or older had lower QoL scores, as well as patients who lived alone, had less than 12 years of education, and experienced complications. The insulin-treated group showed higher scores in DKT than the non-insulin-treated group. It was also found that being male, being under 65 years of age, having no complications present, and having higher levels of knowledge and empowerment predicted higher QoL. Our results show that DKT and DES are still determinants of QoL, even after adjusting for sociodemographic and clinical characteristics. Therefore, literacy and empowerment are important for the improvement of the QoL of people with diabetes, by enabling them to manage their health conditions. New clinical practices focused on education, increasing patients’ knowledge, and empowerment may contribute to better health outcomes.
- A Farmácia Caseira – uma estratégia de desenvolvimento de competências transversais em bioestatística em farmáciaPublication . Cruz, Agostinho; Alves, Sandra Maria; Nascimento, Ana Paula; Santos, Marlene; Correia, Patrícia Carla dos Santos; Jesus, Ângelo; Ferraz Oliveira, Rita; Pinho, Cláudia; Pimenta, RuiEm todas as residências é prática comum a existência de medicamentos e produtos afins, que se encontram a uso, uso esporádico ou que se encontram já fora de uso, como resultado da sua aquisição por prescrição médica ou por iniciativa própria. Se refletirmos na necessidade da existência de boas práticas na organização e gestão desta “Farmácia Caseira”, facilmente verificamos da sua importância em termos não só económicos, mas, principalmente, em termos de saúde pública. Na Escola Superior de Saúde do Instituto Politécnico do Porto (ESS- P.Porto), a utilização da Farmácia Caseira como estratégia pedagógica tem um histórico de mais de 20 anos. Com o objetivo de promover a interdisciplinaridade o grupo de bioestatística utilizou estes dados no desenvolvimento de um conjunto de enunciados de cariz prático na Unidade Curricular (UC) de Fundamentos de Planeamento Experimental do curso de Farmácia, ESS- P.Porto. Estes enunciados permitiram a aplicação prática a dados reais recolhidos pelos estudantes dos conteúdos programáticos da UC (teoria das probabilidades, estatística descritiva e inferencial). Os dados, recolhidos anualmente pelos estudantes, são variáveis de caracterização: i) sociodemográfica do agregado familiar; ii) perfil dos medicamentos existentes na Farmácia Caseira; e iii) condições de armazenamento. A metodologia proposta permitiu: a) integrar a estatística no contexto de atuação dos futuros licenciados; b) enfatizar a componente conceptual da estatística; c) trabalhar com dados reais recolhidos pelos estudantes; d) desenvolver, para além das competências cognitivas, as competências atitudinais, estratégicas e de utilização de novas tecnologias no tratamento da informação. Os instrumentos desenvolvidos foram aplicados com sucesso tornando mais visível a utilidade da bioestatística aplicada à área da farmácia, melhorando a atitude face à aprendizagem da mesma, promovendo uma consciência crítica na análise e aplicação dos métodos estatísticos contribuindo para a formação de profissionais com maior autonomia e capacitados para uma prática baseada na evidência.
- Impact of walking on knee articular cartilage T2 values estimated with a dictionary-based approach - A pilot studyPublication . Coelho, José M.; Fernandes, T.T.; Alves, Sandra Maria; Nunes, R.G.; Nogueira, Luísa; Oliveira, A.Walking is crucial for knee articular cartilage (KAC) health. Routine MRI sequences lack sensitivity for early cartilage changes, and the use of parametric T2 maps to study the effect of walking on KAC composition is limited. This study aimed to evaluate if quantitative T2 maps using an Echo Modulation Curve (EMC) matching algorithm can detect KAC T2 variations due to water content changes after walking. Seven asymptomatic volunteers (3 females, 4 males, mean age 28.3 years) without knee pathologies participated. Sagittal knee MRI scans were performed before and after a 9-min treadmill walk using a Modified Bruce protocol. T2-weighted Multi-Echo Spin-Echo KAC images were acquired at 3T. Tibiofemoral cartilage was segmented semi-automatically on three slices per knee, defining 39 KAC samples. Quantitative T2 maps were created using a dictionary-matching algorithm. Paired t-tests assessed exercise impact on KAC T2 values, independent t-tests compared group differences, and Friedman test with Bonferroni correction evaluated regional T2 changes. Walking increased KAC T2 values (mean difference (md) 0.61 ± 1.71 ms; p ¼ 0.016). Significant differences were observed in “normal” BMI group (md 0.69 ± 1.27 ms; p ¼ 0.021). Regional analysis revealed significant differences in medial femur in males (md 0.9 ± 2.1 ms; p ¼ 0.049) and lateral tibia in females (md 1.4 ± 2.5 ms; p ¼ 0.046). The medial tibia showed significant differences across sub-regions (p ¼ 0.026). Quantitative T2 maps using the EMC matching algorithm detected consistent changes in KAC T2 values after a short walking period. Implications for practice: EMC quantitative T2 maps effectively detected knee cartilage changes postwalking. This technique could improve cartilage hydration assessments, aiding early detection in atrisk patients. It also suggests potential for personalized monitoring and rehabilitation, advancing musculoskeletal imaging and non-invasive joint health monitoring.
- Influência dos fatores psicossociais relacionados com o trabalho na motivação dos trabalhadores: um estudo de caso no setor industrialPublication . Silva, Ana C.; Dores, Artemisa Rocha; Machado, Inês N.; Silva, Miguel R.; Alves, Sandra Maria; Rodrigues, MatildePsychosocial risks are at the origin of negative consequences for organizations and individuals. Despite the potential relationship with the level of workers' motivation, few studies have analyzed this issue in industrial settings. This study aimed to assess work-related psychosocial risk factors and determine their relationship with intrinsic and extrinsic motivation. The study was developed in an industry, and 49 workers were included. The Copenhagen Psychosocial Questionnaire (COPSOQ II) was used to assess psychosocial factors, and the Work Extrinsic and Intrinsic Motivation Scale (WEIMS) was used to assess motivation. The subscales "job insecurity", "cognitive demands", "emotional demands", "social support from superiors" and "influence at work" showed relevant risk values for workers' health, so they should be prioritized in the intervention. The motivational dimensions that presented the highest values were "intrinsic motivation" and "external regulation". Significant associations were found between the variables under study. This study reinforces that work-related psychosocial risk factors are associated with workers' motivation.
- Knowledge about type 2 diabetes: its impact for future managementPublication . Ferreira, Pedro L. ; Morais, Carminda ; Pimenta, Rui; Ribeiro, Inês ; Amorim, Isabel ; Alves, Sandra Maria; Santiago, LuizDiabetes can cause several long-term complications. Knowledge about this disease can play an important role in reducing diabetes-related complications. In addition, the lack of awareness leads to misconceptions, which joined with inadequate knowledge, are relevant barriers to proper diabetes management. In this study, we aimed to assess the diabetes knowledge of a type 2 diabetes (T2D) population and identify major knowledge gaps, in order to prevent complications and to increase quality of life. In a cross-sectional, observational study in a convenience sample, we identified individuals diagnosed with T2D attending ambulatory visits from five health settings, older than 18 years, with a time diagnosis of at least 1 year, and attending multidisciplinary visits for at least 3 months. To assess the knowledge of T2D individuals, we applied the Portuguese version of the Diabetes Knowledge Test. The sample included a total of 1,200 persons, of whom almost half were female. The age range of the participants varied from 24 to 94 years old, and the mean age was 65.6 ± 11.4 years. Most of the sample had a level of education under secondary and lived with someone. In our sample, 479 (39.9%) were insulin-treated. The percentage of correct answers was 51.8% for non-insulin vs. 58.7% for insulin treated (p < 0.05). There were three items with a percentage of correct answers lower than 15%; the item with the lower value of correct answers was the one related to the identification of signs of ketoacidosis with only 4.4% of correct answers, the errors presented a random pattern; the item related to the identification of which food should not be used to treat low blood glucose with 11.9%, where 56.9% of the sample’s participants considered that one cup of skim milk would be the correct answer (53.1% in non-insulin patients and 62.6% in insulin treated patients; p < 0.001). The item regarding the knowledge of free food presented a 13.3% of correct answers (10.8% non-insulin group vs. 17.1% insulin group; p < 0.01). Two of the three items with lower value of correct answers were related to glycemic control and health status monitoring, the other was related to diet and food.
- Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000-2010) in Portugal: age and sex temporal trends in a population based studyPublication . Oliveira, Carla Maria; Alves, Sandra Maria; Pina, Maria De FátimaBackground: Socioeconomic factors may influence changes in hip fracture (HF) incidence over time. We analysed HF temporal trends during the Bone and Joint Decade in Portugal (BJD-Portugal), 2000–2010, by regional socioeconomic status (SES), sex and age. Methods: We selected registers of patients aged 50+ years with HF (International Classification of Diseases, V.9—Clinical Modification, ICD9-CM) caused by traumas of low/moderate energy, from the National Hospital Discharge Database. Annual time series of age-specific incidence rates were calculated by sex and regional SES (deprived, medium, affluent). Generalised additive models were fitted to identify shape/turning points in temporal trends. Results: We selected 96 905 HF (77.3% in women). Women were older than men at admission (81.2±8.5 vs 78.2±10.1 years-old, p<0.001). For women 65–79 years, a continuously decreasing trend (1.7%/year) only in affluent and increasing trends (3.3–3.4%/year) after 2006/2007 in medium and deprived was observed. For men, trends were stable or increased in almost all age/SES groups (only two decreasing periods). For the oldest women, all SES present similar trends: turning points around 2003 (initiating decreasing periods: 1.8–2.9%/year) and around 2007 (initiating increasing periods: 3.7–3.3%/year). Conclusions: There were SES-sex-age inequalities in temporal trends during BJD-Portugal: marked SES inequalities among women aged 65–79 years (a persistent, decreasing trend only in the affluent) vanished among the oldest women; the same was not observed in men, for them, there were almost no declining periods; women aged ≥80 years, presented increasing trends around 2007, as in most deprived/age/sex groups. Despite some successful periods of decreasing trends, incidence rates did not improve overall in almost all age groups and both sexes.
- Osteoporotic hip fractures: Bisphosphonates sales and observed turning point in trend. A population-based retrospective studyPublication . Alves, Sandra Maria; Economou, Theodoros; Oliveira, Carla Maria; Ribeiro, Ana Isabel; Neves, Nuno; Goméz-Barrena, Enrique; Pina, Maria de FátimaThe aim is to examine the temporal trends of hip fracture incidence in Portugal by sex and age groups, and explore the relation with anti-osteoporotic medication. From the National Hospital Discharge Database, we selected from 1st January 2000 to 31st December 2008, 77,083 hospital admissions (77.4% women) caused by osteoporotic hip fractures (low energy, patients over 49 years-age), with diagnosis codes 820.x of ICD 9-CM. The 2001 Portuguese population was used as standard to calculate direct age-standardized incidence rates (ASIR) (100,000 inhabitants). Generalized additive and linear models were used to evaluate and quantify temporal trends of age specific rates (AR), by sex. We identified 2003 as a turning point in the trend of ASIR of hip fractures in women. After 2003, the ASIR in women decreased on average by 10.3 cases/100,000 inhabitants, 95% CI (− 15.7 to − 4.8), per 100,000 anti-osteoporotic medication packages sold. For women aged 65–69 and 75–79 we identified the same turning point. However, for women aged over 80, the year 2004 marked a change in the trend, from an increase to a decrease. Among the population aged 70–74 a linear decrease of incidence rate (95% CI) was observed in both sexes, higher for women: − 28.0% (− 36.2 to − 19.5) change vs − 18.8%, (− 32.6 to − 2.3). The abrupt turning point in the trend of ASIR of hip fractures in women is compatible with an intervention, such as a medication. The trends were different according to gender and age group, but compatible with the pattern of bisphosphonates sales.
- Proceedings of the 1st Symposium on Biostatistics and Bioinformatics Applied to HealthPublication . Faria, Brígida Mónica; Martins, João Paulo; Alves, Sandra Maria; Pimenta, Rui; Faria, Brigida Monica; Pimenta, Rui; Oliveira Martins, João PauloThe proceedings of the First Symposium on Biostatistics and Bioinformatics Applied to Health (1st SBBAH) highlight the convergence of innovation and health sciences, presenting research and developments in the field. On May 3, we welcomed participants for an engaging day of discussions, beginning with an opening session that set the stage for the day’s presentations. The Symposium was organized with a diverse set of oral communications, including students and Alumni from the Master on Biostatistics and Bioinformatics Applied to Health (MBBAS) program, who presented their findings on topics ranging from machine learning applications in healthcare to the functional activity of astrocytes. An invited talk on Natural Language Processing and the role of Artificial Intelligence in Healthcare emphasized the importance of these technologies in shaping the future of health research. We extend our gratitude to all speakers, participants, companies and organizing committees for their commitment and contributions, making this Symposium a significant way for knowledge exchange and collaboration in health, biostatistics, bioinformatics, data science and artificial intelligence. We also would like to express our heartfelt gratitude to the MBBAS first year students who invented the symposium logo, showcasing their creativity and dedication. Additionally, we extend our thankfulness to Hospital das Forças Armadas – Polo Porto for generously hosting us in their facilities and for their sponsorship, which greatly contributed to the success of this event. Their support highlights the collaboration between academia and healthcare institutions, promoting innovation in health and science.
- Regional drinking water composition effects on hip fracture risk: a spatial analysis of nationwide hospital admissions in Portugal, from 2000 to 2010Publication . Oliveira, Carla Maria; Teixeira, Hugo; Alves, Sandra Maria; Pina, Maria FátimaA variabilidade espacial existente na fratura do colo do fêmur (FCF) pode estar relacionada com a variabilidade geográfica da composição da água para consumo (CAC), devido à ação dos minerais na fragilidade óssea. O objetivo do artigo foi investigar o efeito da CAC no risco de FCF em Portugal (2000-2010). Do registo nacional de altas hospitalares, foram selecionadas todas as admissões em indivíduos ≥50, com diagnóstico de FCF causado por trauma de baixo/moderado impacto. Os componentes e características da água foram usados ao nível do município. Um modelo espacial aditivo generalizado, com a distribuição binomial negativa como função de ligação, foi usado para estimar a associação de FCF e as variações da CAC. Foram selecionadas 96.905 FCF (77,3% em mulheres).