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- Time to death in a prospective cohort of 252 patients treated for fracture of the proximal femur in a major hospital in PortugalPublication . Campos, Sónia; Alves, Sandra Maria; Carvalho, Marilia Sá; Neves, Nuno; Trigo-Cabral, Abel; Pina, Maria FátimaThe objectives were to analyze one-year survival and mortality predictors in patients with fracture of the proximal femur (low/moderate trauma). A prospective cohort was formed by inviting all patients hospitalized in the Orthopedic Ward of the second largest hospital in Portugal (May 2008-April 2009). Survival was assessed at 3, 6, 9, and 12 months after fracture and related to demographic factors, lifestyle, and clinical history, as well as to data from medical records (fracture type, surgery date, surgical treatment, and preoperative risk). Of the 340 patients hospitalized, 252 were included (78.9% women). Mortality at 3, 6, 9, and 12 months was 21.2%, 25%, 28.8%, and 34.6% for men and 7.8%, 13.5%, 19.2%, and 21.4% for women, respectively. Predictors of death were male gender (HR = 2.54; 95%CI: 1.40-4.58), ASA score III/IV vs. I/II (HR = 1.95; 95%CI: 1.10-3.47), age (HR = 1.06; 95%CI: 1.03-1.10), and delay in days to surgery (HR = 1.07; 95%CI: 1.03-1.12). Factors related to death were mainly related to patients' characteristics at admission.
- Multidose drug dispensing systems: a market studyPublication . Reis, Ana; Alves, Sandra; Jesus, Ângelo; Calvo, MaríaThis study investigates the willing to pay for a Multidose Drug Dispensing System(MDD)in pharmacies. The main aim of this study is to determine whether MDD is perceived as important in society (users or not) and their willing to pay for it. OMS concluded that increasing interventions to improve adherence to therapy may have more impact on the population’shealth than any improvement in medicaltreatment. Non-adherence is the main cause of avoidable costs for the National Healthcare System. This is an observational, cross-sectional descriptive study. Structured online questionnaire was conducted with 263 participants. It was applied a binary simple logistic regression to quantify how different the risk is between variables. From 261 respondents, 75.5%were female. The youngest respondent was 19 and the oldest 83 years old. About 40% had a BSc and about 45%of the respondents were patients. 84% refer no difficulty with medication intake and about 60% report no chronic disease. 59% refer that the service would not be useful to self, however only 6% consider the service not useful to a family member/acquaintance. About 76% of the respondents refer to be willing to pay for this service (67%would consider pay 10euros or less). Female population may present an estimated reduction of about 43% in the willing to pay compared to male population. When respondents were family members the willing to pay increase compared to when they were patients (126%). Finally, the population that recognize the importance of the service for a family member/acquaintance is expected to have anestimated increase in the willing to pay of about 190% when compared to the population that does not recognize that importance. In this study, generally, MDD service was perceived as important and men, more than women, havethe willing to pay for it.
- Epidemiologia das fracturas do fémur em Portugal - Fracturas do colo do fémur versus fracturas de outras localizações não especificadas do fémurPublication . Alves, Sandra; Pina, Maria de Fátima; Barbosa, MárioUm aumento na ocorrência de fracturas atribuídas à osteoporose tem vindo a ser reportado em diversos países. As fracturas do colo do fémur são frequentemente estudadas, no entanto pouco se sabe de outras fracturas que também podem ser relacionadas com a osteoporose. O objectivo principal deste estudo é comparar a incidência das fracturas do colo do fémur atribuíveis à osteoporose com as que acontecem nas mesmas condições noutras localizações não especificadas do fémur. Foi utilizada a base de dados do Instituto de Gestão Informática e Financeira da Saúde, no período de 2000 a 2002. Do total de internamentos por fractura do fémur foram seleccionados os registos relativos a fracturas de baixa energia em indivíduos com mais de 50 anos, e analisadas separadamente as fracturas no colo do fémur (códigos 820 e derivados da Classificação Internacional de Doenças, 9ª Revisão, Modificação Clínica CID9) das fracturas de localizações não classificadas em outra parte, ou de localizações não especificadas do fémur (CID9-MC: 821 e derivados). Calcularam-se as letalidades e as taxas de incidência do período, por faixa etária e sexo, e efectuou-se uma análise das variáveis idade, dias e custo de internamento e destino após saída. Apenas 7,6% das fracturas do fémur seleccionadas foram codificadas como 821.x, todas as restantes foram codifica das como 820.x. Em ambos os grupos as fracturas são mais frequentes nas mulheres (acima de 75%) e apresentam um aumento exponencial com a idade. Os custos são mais elevados nas fracturas 820.x que também apresentam as taxas de letalidade mais elevadas.
- Bone decade actions: are practical results measurable yet?Publication . Alves, Sandra; Oliveira, Carla; Alves, Carlos; Ribeiro, Ana I.; Neves, Nuno; Pina, Maria F.Osteoarthritis (OA) has an extremely high disease and economic burden. Despite treatments for OA pain management, data are limited on the adequacy of pain relief in OA patients. SORT will determine the adequacy of pain relief in patients with knee OA and compare patterns of clinical care and outcomes.
- Apparent diffusion coefficient in the analysis of prostate cancerPublication . Adubeiro, Nuno; Nogueira, Luísa; Ribeiro, Eduardo; Alves, Sandra; Ferreira, Hugo; La Fuente, JoséThe multiparametric magnetic resonance imaging (MPMRI) approach, has allowed the diagnostic performance in the detection and characterization of prostate cancer (PCa). Diffusion-weighted imaging (DWI), is an important technique in the MPMRI, that provides qualitative and quantitative biological information regarding water diffusivity in a non-invasive manner. The apparent diffusion coefficient (ADC) measures water mobility and can be quantified from the signal intensity loss between two or more b-values. Different studies reported that ADC values are directly associated with microvessel density and cellularity. One of the main aspects that is in discussion is the b-values that must be used in the DWI sequence in order to compute ADC.
- How we are treating osteoporotic hip fractures (OHF)? A nationwide observational study in PortugalPublication . Alves, Carlos M. F. P.; Alves, Sandra; Pina, Maria F.Analyze changes in treatment of osteoporotic hip fractures (OHF) in Portugal, between 2000-2008. Discharges with diagnosis of hip fracture between 2000-2008 were collected from the national register of hospital discharges, mandatory for all Portuguese public hospitals. Chi-square test was used to access independence between sex, age groups, treatment and fatality. Linear regression was used to access temporal trends
- 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.
- Research of Legionella sp. in the water supply of a hospital in northern PortugalPublication . Alves, Sandra Maria; Lamas, Maria Céu; Araújo, António; Amorim, ManuelaThe distribution systems of drinking water have characteristics that allow the growth of microorganisms that may be pathogenic to humans, such as Legionella. The Legionella sp. (aerobic gram-negative bacilli) are widely distributed in aquatic environments, but it is in artificial environments that they hit higher levels due the characteristics propitious (like temperature, pH and biofilms presence) to their development. Human intervention was crucial for the presence of Legionella that has become common in building networks of water supply, cooling towers, air conditioning systems, swimming pools, tanks, humidifiers, condensers, ornamental fountains, among others.
- Survival in the elderly following a proximal femur fracture: one-year follow-up studyPublication . Campos, Sónia; Alves, Sandra Maria; Cabral, Abel Trigo; Pina, Maria FátimaThe aim of this study was to determine the one year survival rate after a proximal femur fracture and to investigate the predictors for fatality. All patients that were admitted, with an acute proximal femur fracture caused by a fall of low energy impact from 1 May 2008 - 30 April 2009 in a main portuguese hospital were invited to participate in the study.
- 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.
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