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- Seasonal influenza vaccine effectiveness in persons aged 15–64 years: a systematic review and meta-analysisPublication . Martins, João Paulo; Santos, Marlene; Martins, André; Felgueiras, Miguel; Santos, RuiInfluenza is a respiratory disease caused by the influenza virus, which is highly transmissible in humans. This paper presents a systematic review and meta-analysis of randomized controlled trials (RCTs) and test-negative designs (TNDs) to assess the vaccine effectiveness (VE) of seasonal influenza vaccines (SIVs) in humans aged 15 to 64 years. An electronic search to identify all relevant studies was performed. The outcome measure of interest was VE on laboratory-confirmed influenza (any strain). Quality assessment was performed using the Cochrane risk-of-bias tool for RCTs and the ROBINS-I tool for TNDs. The search identified a total of 2993 records, but only 123 studies from 73 papers were included in the meta-analysis. Of these studies, 9 were RCTs and 116 were TNDs. The pooled VE was 48% (95% CI: 42–54) for RCTs, 55.4% (95% CI: 43.2–64.9) when there was a match between the vaccine and most prevalent circulating strains and 39.3% (95% CI: 23.5–51.9) otherwise. The TNDs’ adjusted VE was equal to 39.9% (95% CI: 31–48), 45.1 (95% CI: 38.7–50.8) when there was a match and 35.1 (95% CI: 29.0–40.7) otherwise. The match between strains included in the vaccine and strains in circulation is the most important factor in the VE. It increases by more than 25% when there is a match with the most prevalent circulating strains. The laboratorial method for confirmation of influenza is a possible source of bias when estimating VE.
- Mean value estimation using low size samples extracted from skewed populationsPublication . Martins, João P.; Felgueiras, Miguel; Santos, RuiThe use of the 𝑇-statistic in statistical inference procedures is usually restricted to normal populations or to large samples. However, these conditions may not be fulfilled in some situations: the population can be moderate/highly skewed, or the sample size can be small. In this work, we use the Pearson’s system of distributions, namely, type IV distributions to model 𝑇. By some simulation work, it is shown that this approximation leads to confidence intervals whose coverage is close to the nominal coverage even for low sample sizes.
- Sources of bias when assessing seasonal Influenza vaccine performance: a narrative reviewPublication . Martins, André Miguel; Juan, Luis Félix Valero; Santos, Marlene; Martins, João PauloThe best way to prevent influenza infection is through vaccination. Evaluating vaccine performance is essentially done through two types of study: clinical trials and the test negative design, an observational study derived from the case control. While in clinical trials the sources of bias are perfectly identified and there are specific tools for assessing them, in test negative design we find very varied sources of bias and a lot of scattered information without there being a validated tool for assessing the risk of bias. The aim of this narrative review is to identify the most important sources of bias in both types of study and to contribute to the development of a risk assessment tool for test negative design studies, given their major importance in evaluating the performance of the seasonal influenza vaccine.
- A meta-analysis on the role of sonication in the diagnosis of cardiac implantable electronic device-related infectionsPublication . Araújo, Daniela; Martins, João P.; Ferreira, Stephanie; Mota, Sandra; Ferreira, Pedro L. ; Pimenta, RuiOne of the biggest obstacles in diagnosing Implant-Associated Infections is the lack of infection criteria and standardized diagnostic methods. These infections present a wide range of symptoms, and their diagnosis can be hampered by the formation of microbial biofilms on the surface of implants. This study aimed to provide insight into the performance of sonication in the diagnosis of infections associated with Cardiac Implantable Electronic Devices, to help define a consensus on the algorithm for the microbial diagnosis of these infections. We carried out a systematic review with meta-analysis. The PRISMA methodology guidelines were followed, and an advanced search was carried out in PubMed and Web of Science, which enabled 8 articles to be included in the review, in which a meta-analysis was also carried out. QUADAS-2 was used to assess the risk of bias and effect measures were calculated to assess publication bias. The overall sensitivity of the method was 0.823 (95% CI: 0.682–0.910) and the specificity was 0.632 (95% CI: 0.506–0.743). These results suggest that sonication may offer advantages in diagnosing these infections. However, it is essential to approach these findings carefully and take into account the recommendations provided in the EHRA 2019 guidelines. This study highlights the importance of more effective diagnostic approaches for implantable medical device-associated infections to improve the quality of treatment and minimize the risks associated with these challenging medical conditions.
- Demand for emergency services during the COVID-19 pandemic and disease burden: a case study in PortugalPublication . Nunes, Alcina ; Costa, Catarina ; Martins, João P.; Ferreira, Pedro L.; Pimenta, RuiThe COVID-19 pandemic brought changes in the pattern of care use. A significant increase in the volume of emergencies was expected. However, a significant decrease was observed worldwide. An observational, analytical and cross-sectional study of all records of emergency episodes of patients aged 18 years or older admitted to the emergency services of the University of Porto Hospital Centre (2018–2022) were analysed. : During the pandemic, a significant reduction in emergency episode admissions (up to 40% during lockdowns), an increase in pre-emergency services, and discharges from Infectious Diseases and Internal Medicine was observed. The discharges from General Practice and General Practice and Family Medicine were residual. The lower use and type of use of emergency services during the COVID-19 pandemic had a negative impact on the disease burden. This could be prevented in future pandemics through the development of strategies to promote confidence in the use of health resources and establishing contingency plans for virtual assistance.
- Health care expenses impact on the disability-adjusted life years in non-communicable diseases in the European UnionPublication . Torres, Margarida ; Nunes, Alcina ; Martins, João P.; Ferreira, Pedro L. ; Pimenta, RuiNon-communicable diseases are a global health problem. The metric Disability-Adjusted Life Years was developed to measure its impact on health systems. This metric makes it possible to understand a disease’s burden, towards defining healthcare policies. This research analysed the effect of healthcare expenditures in the evolution of disability-adjusted life years for noncommunicable diseases in the European Union between 2000 and 2019. Data were collected for all 27 European Union countries from Global Burden of Disease 2019, Global Health Expenditure, and EUROSTAT databases. Econometric panel data models were used to assess the impact of healthcare expenses on the disability-adjusted life years. Only models with a coefficient of determination equal to or higher than 10% were analysed. There was a decrease in the non-communicable diseases with the highest disability-adjusted life years: cardiovascular diseases (−2,952 years/105 inhabitants) and neoplasms (−618 years/105 inhabitants). Health expenditure significantly decreased disability-adjusted life years for all analysed diseases (p 0.05) whereas public health expenditure did not significantly influence skin and subcutaneous diseases (p > 0.05). Health expenditure have proved to be effective in the reduction of several diseases. However, some categories such as musculoskeletal and mental disorders must be a priority for health policies in the future since, despite their low mortality, they can present high morbidity and disability.
- Immunogenicity as a predictor of Influenza vaccine efficacy: A systematic reviewPublication . Martins, André Miguel; Juan, Luis Félix Valero; Santos, Marlene; Martins, João Paulo; Santos, Marlene; Oliveira Martins, João PauloInfluenza represents a significant burden on global public health, and vaccination is the most effective strategy to reduce it. The large investment in vaccination programs and the need for adjustments in vaccine serotypes are important reasons for evaluating the influenza vaccine’s efficacy every year. Establishing a relationship between immunogenicity data and efficacy is also crucial for predicting the efficacy of a vaccine during its development. Antibody response measurement is one of the most common methods for evaluating immunogenicity, particularly in vaccines and biologics. The aim of this systematic review was to define a model that relates the immunogenicity of a given vaccine to its efficacy, based on hemagglutination inhibition titer levels. To achieve this goal, information was gathered from articles linking immunogenicity with the efficacy of the influenza vaccine in the Medline and Scopus databases. Different mathematical models were developed and applied to assess the relationship between HAI titers and the effectiveness of the flu vaccine. This analysis was conducted for the various existing vaccines, for the different influenza virus strains, and for their efficacy in paediatric populations. The r2 obtained ranged from 0.2579 to 0.966, which points to the importance of this immunological factor in the efficacy of the influenza vaccine. Conclusions: The efficacy values for titer level 40 confirm the validity of the data provided by Hobson.
- Medication review improves pain management and quality of life in chronic pain: a pilot randomized controlled studyPublication . Duarte, Nuno; Martins, João Paulo; García-Domingo, Mónica; A. García-Pedraza, Jose; Santos, Marlene; Santos, Marlene; Oliveira Martins, João Paulo; Duarte, NunoChronic pain is a complex condition that benefits from a multidisciplinary approach. This pilot parallel-group single-blinded randomized controlled study evaluated the feasibility, acceptability and adherence by patients and physicians of pharmacist-led medication review on chronic pain patients. Trends in pain intensity, quality of life and patient satisfaction were examined. Twenty adults were recruited from two primary care units in Porto, Portugal, and randomly assigned to either the medication review (MR) group, (n=10) using the Dader method, or the usual care (UC) group, (n=10) and given general advice, for 16-weeks. Pain intensity decreased by 2.07 (MR group) and increased by 0.52 (UC group), yielding an adjusted mean difference of 2.77 (95% CI, -4.93 to -0.62; p=0.008). Pain relief was reported by 62.5% in the MR group versus 37.5% in UC (p=0.357). The MR group showed significant improvement in physical functioning (p=0.019) and higher treatment satisfaction (p=0.029). The acceptance rate of MR interventions was 71%, which resolved 63% of negative medication outcomes. Acceptability was high (>90% of planned interviews). Conducting pharmacist led MR for chronic pain management in primary care is feasible and well accepted by patients and physicians. Observed trends toward improved pain and QoL warrant confirmation in a larger trial. This pilot trial was registered in clinicaltrials.gov (NCT06997861).
- Is endometriosis staging related to the type and intensity of patients’ complaints? A systematic review and meta-analysisPublication . Alves, João Sequeira; Meneses, Tânia; Mariano, Mafalda; Serra, Sofia Silvério; Costa, Teresa; Martins, João Paulo; Rabishong, Benoit; Lima, Jorge; Oliveira Martins, João PauloTo evaluate the association between the endometriosis staging and the type and intensity of pain reported by patients, describing the pain intensity across different pain types. On January 27, 2025, a systematic search was conducted in PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library. The search terms included endometriosis, pain, dysmenorrhea, dyspareunia, pelvic pain, dyschezia, dysuria, and classification. Eligible studies examined women with endometriosis, assessing how endometriosis staging (rASRM or ENZIAN classification) correlated with pain symptoms (dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain) measured with validated tools. Two reviewers extracted data independently, with a third verifying results. Pain scores were log-transformed to stabilize variance, and proportions of women with advanced endometriosis were analyzed on the logit scale. Given high heterogeneity, random-effects models with restricted maximum likelihood were used. Of 2527 records, 112 studies were reviewed and eight met inclusion criteria (seven using rASRM, one using ENZIAN). Dysmenorrhea showed the highest mean intensity (6.61, 95% CI: 4.43–10.10), while dysuria was lowest (1.08, 95% CI: 0.62–1.89). Pain intensity did not differ significantly between rASRM stages I/II and III/IV (p > 0.05), though chronic pelvic pain was more frequent in advanced disease (p < 0.05). Dysmenorrhea is linked to higher pain intensity in women with endometriosis, while dysuria is linked to lower intensity. Pain intensity is not associated with the rASRM stage; however, chronic pelvic pain seems more prevalent in advanced stages of the disease.
- Is pharmacist-led medication review effective in reducing pain intensity and improving quality of life in chronic pain primary care patients?Publication . Duarte, Nuno; García-Pedraza, J. A.; Martins, João Paulo; Santos, Marlene; Santos, Marlene; Oliveira Martins, João Paulo; Duarte, NunoChronic pain patients in primary care often present with diverse pain conditions and underlying causes. The multidimensional nature of chronic pain constitutes a significant challenge to its management and assessment [1]. Medication review (MR), using the Dader method, involves a systematic evaluation of a patient’s pharmacotherapy to optimize treatment. An advantage of this method is the adaptability to all healthcare settings [2,3]. This study aims to assess the impact of pharmacist-led MR on pain intensity (PI) and quality of life (QoL) in primary care patients with chronic pain.