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Kefir, a traditional fermented food, has numerous health benefits due to its unique chemical composition, which is reflected in its excellent nutritional value. Physicochemical and microbial composition of kefir obtained from fermented milk are influenced by the type of the milk, grain to milk ratio, time and temperature of fermentation, and storage conditions. It is crucial that kefir characteristics are maintained during storage since continuous metabolic activities of residual kefir microbiota may occur. This study aimed to examine the nutritional profile of kefir produced in traditional in use conditions by fermentation of ultra-high temperature pasteurized (UHT) semi-skimmed cow milk using argentinean kefir grains and compare the stability and nutritional compliance of freshly made and refrigerated kefir. Results indicate that kefir produced under home use conditions maintains the expected characteristics with respect to the physicochemical parameters and composition, both after fermentation and after refrigerated storage. This work further contributes to the characterization of this food product that is so widely consumed around the world by focusing on kefir that was produced in a typical household setting.

The papers published in this book of abstracts / proceedings were submitted to the Scientific Commission of the International Congress of Research Center in Sports Sciences, Health Sciences & Human Development, held on 11 and 12 November 2016, at the University of Évora, Évora, Portugal, under the topic of Exercise and Health, Sports and Human Development. The content of the abstracts is solely and exclusively of its authors responsibility. The editors and the Scientific Committee of the International Congress of Research Center in Sports Sciences, Health Sciences & Human Development do not assume any responsibility for the opinions and statements expressed by the authors. Partial reproduction of the texts and their use without commercial purposes is allowed, provided the source / reference is duly mentioned.

This data article includes data and analyses on the effect of different agronomic techniques on the production of Polygonum maritimum L. (sea knotgrass), namely different salinity irrigation treatments (0, 100, 200, 300 and 600 mM of NaCl) and a multi-harvest regime, and their relation with the chemical profile (ultra-high-resolution mass spectrometry - UHRMS), in vitro antioxidant [radical-scavenging activity (RSA) of DPPH and ABTS, copper chelating activity and ferric reducing antioxidant power] and anti-inflammatory (nitric oxide reduction on lipopolysaccharide-stimulated macrophages) activities. For further interpretation of the data presented in this work, please see the related research article “The irrigation salinity and harvesting affect the growth, chemical profile and biological activities of Polygonum maritimum L.” (Rodrigues et al., 2019). Keywords: Antioxidant activity, Anti-inflammatory activity, Halophyte domestication, Saline agriculture

Background: Children of parents with mental illness (COPMI) are a high-risk group. There is a strong association between parents’ psychiatric disorders and the incidence of psychopathology in their children. These children need to be identified and supported by mental health workers early, and hence, clinical practice in adult mental health services needs to change from a focus on individual patients to a more systemic family focus. “Semente,” a mental health promotion program developed by the Psychiatry Service of Fernando Fonseca hospital (Lisbon, Portugal), had been established to identify these children and families and promote their mental health, by decreasing the impact of risk factors and promoting protective factors. The program included preventive COPMI interventions and implementation of activities offered to families with children in the mental health care. The aim of the present study was to evaluate changes in mental health care after the training in “Child Talks” intervention (two to three psycho-educational meetings with parents and children) and implementation of the “Semente” program.Methods: Participants (N = 51) were all professionals from Psychiatric Service of Fernando Fonseca Hospital who received Child Talks training. The Family-Focused Mental Health Practice Questionnaire (FFMPQ) was used to measure change in professionals’ attitudes, knowledge, confidence, and organizational structure in working with these families. All participants filled in the questionnaire before training and 10 months later.Results: The results showed that, from pre- to post-measurement, the professionals changed clinical practice significantly. The largest changes were visible in the improved provision of support at the workplace for family-focused practice and the clarity and availability of the policies and procedures. Furthermore, the skill and knowledge of the mental health workers showed significant improvement at posttest.Conclusion: The positive results of this study were not unexpected; the training, implementation of routines, and procedures as well as workplace support were aims of the “Semente” program. Interpretation of the results should be taken with caution because of the small sample and the lower reliability of some of scales of the FFMPQ. The results indicate that professionals moved from patient focus to family focus during the implementation of the “Semente” program.

Cardiac angiosarcoma (CA) is the most common primary malignant heart tumour. Its atypical symptoms and rapidly progressive nature contribute to delayed diagnosis and poor outcome. We report the case of a 52-year-old woman admitted with a large pericardial effusion. An extensive study of the aetiology of the pericardial effusion was inconclusive. Two months later the patient returned with ischaemic stroke. An echocardiogram revealed a probable right atrium contained rupture. The patient was submitted to surgical correction but died 9 days later. Histology revealed an angiosarcoma. This case exemplifies the atypical presentation of CA and highlights the importance of a multimodal diagnostic work-up in patients with idiopathic pericardial effusion.

Abstract The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.

Thus far, few studies have examined the estimation and actual performance of locomotor ability in older adults. To our knowledge, there are no studies examining the relationship between stepping-forward estimation versus ability and fall occurrence. The aim of this study was to develop and assess the reliability and validity of a new test for fall risk assessment in community-dwelling older adults. In total, 347 participants (73.1 ± 6.2 years; 266 women) were assessed for their perception of maximum distance for the stepping-forward and action boundary. The test was developed following the existing literature and expert opinions. The task showed strong internal consistency. Intraclass correlation ranged from 0.99 to 1 for intrarater agreement and from 0.83 to 0.97 for interrater agreement. Multivariate binary regression analysis models revealed an area under the curve (AUC) of 0.665 (95% CI: 0.608-0.723) for fallers and 0.728 (95% CI: 0.655-0.797) for recurrent fallers. The stepping-forward affordance perception test (SF-APT) was demonstrated to be accurate, reliable and valid for fall risk assessment. The results showed that a large estimated stepping-forward associated with an underestimated absolute error works as a protective mechanism for fallers and recurrent fallers in community-dwelling older adults. SF-APT is safe, quick, easy to administer, well accepted and reproducible for application in community or clinical settings by either clinical or nonclinical care professionals.

Cardiovascular (CV) toxicity is nowadays recognized as a class effect of non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs). However, their mechanisms of cardiotoxicity are not yet well understood, since different compounds with similar action mechanisms exhibit distinct cardiotoxicity. For instance, diclofenac (DIC) is among the most cardiotoxic compounds, while naproxen (NAP) is associated with low CV risk. In this sense, this study aimed to unravel the role of drug-lipid interactions in NSAIDs-induced cardiotoxicity. For that, DIC and NAP interactions with lipid bilayers as model systems of cell and mitochondrial membranes were characterized by derivative spectrophotometry, fluorometric leakage assays, and synchrotron X-ray scattering. Both DIC and NAP were found to have the ability to permeabilize the membrane models, as well as to alter the bilayers’ structure. The NSAIDs-induced modifications were dependent on the lipid composition of the membrane model, the three-dimensional structure of the drug, as well as the drug:lipid molar ratio tested. Altogether, this work supports the hypothesis that NSAIDs-lipid interactions, in particular at the mitochondrial level, may be another key step among the mechanisms underlying NSAIDs-induced cardiotoxicity.

Introduction: To perform a cost-effectiveness analysis of follicular lymphoma maintenance treatment after first-line induction with rituximab compared to observation in Portugal. Methods: A Markov follicular lymphoma model was developed with four health states: progression free survival on first and second lines, progression and death. The transition probabilities between health states were obtained from the PRIMA and EORTC20981 clinical trials and the health states utilities from the literature. The analysis considered the Portuguese National Health Service perspective and includes only direct costs. Resource consumption was estimated by a Portuguese clinical expert panel. The unit costs (€ in 2014) were estimated using Portuguese official databases. Deterministic and probabilistic analyses were performed. Results: In the base case, for a time horizon of 10 years, the cost per life year gained and per quality-adjusted life-year were € 10,634 and € 10,664, respectively. The sensitivity analyses confirmed the stability of the base case for time horizons of 20 and 30 years, varying between € 7,430 and € 7,155. Maintenance with rituximab is cost-effective for a time horizon of 5.5 years (cost per quality-adjusted life-year gained of € 23,616). Conclusion: According to the present model rituximab maintenance treatment of follicular lymphoma patients that respond to first line induction therapy in comparison with observation is cost-effective in Portugal.

As a part of a multidisciplinary and integrated research, including conservation sciences and history, a proposal is presented for the historical reconstitution and the virtual restoration of the mannerist altarpiece of the main altar at the Espírito Santo Church, in Évora. The collected data is abundant and the scientific information, because of its technicality, is less prone to be easily understood by the general public, thus becoming less accessible. Web-based infographics are explored as privileged forms of disseminating results and raising awareness to Cultural Heritage. The project materializes as an Internet platform where data and a reconstitution proposal are shared in a visual and interactive way. In addition to the digital virtual reconstitution (2D), some tridimensional models (3D) are presented of various elements of the altarpiece, obtained using methods of computer graphics and digital photogrammetry.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background and objectives: Peritoneal dialysis (PD) patients are expected to present lower levels of physical activity, unhealthy changes at the body composition level, and low levels of strength. Firstly, this study aimed to report the sex differences in physical activity, body composition and muscle strength and the relations among these variables. Secondly, we analyze the relationship between physical activity and biochemical parameters. Materials and Methods: Thirty-four patients (13 women and 21 men) participated in this study. Body composition was assessed by bioimpedance and dual-energy X-ray absorptiometry (DXA), and maximum isokinetic unilateral strength, analytical parameters and physical activity levels were evaluated. Results: The men showed higher values for weight, height, lean body mass, bone mineral content, bone mineral density (BMD) and total body water, while women showed higher values for the percentage of fat mass and hydration of lean body mass (p < 0.05). No differences between the sexes were found in different levels of physical activity; however, males registered significantly higher values for isokinetic strength variables except for knee extensor strength. BMD was positively related to sedentary activity and negatively related to moderate and vigorous activity (r = 0.383 and r = −0.404, respectively). Light physical activity was negatively correlated with albumin (r = −0.393) and total protein (r = −0.410) levels, while moderate/vigorous activity was positively correlated with urea distribution volume (r = 0.446) and creatinine clearance (r = 0.359) and negatively correlated with the triglyceride level (r = −0.455). Conclusions: PD patients with higher levels of physical activity present better results in terms of body composition and biochemical parameters. Additional studies should be conducted to clarify the relation between physical activity level and BMD.

O presente artigo resulta de uma investigação realizada no âmbito do tema “Quotidianos e Sociabilidades Portuenses no Contexto da Grande Guerra” desenvolvida entre a Escola Superior de Educação do Porto e o Arquivo Distrital do Porto. Procura, através da análise de quatro fundos – Processos de Passaporte dos Emigrantes (cartas de chamada); Companhia de Carris de Ferro do Porto; Processos de Admissão da Casa dos Hospícios do Porto (Casa da Roda); e, Livro de Registos Notariais – contribuir para o conhecimento dos quotidianos e sociabilidades na cidade do Porto durante a I Guerra Mundial, mais concretamente no ano de 1917. Pretende-se esboçar a importância dos arquivos como fonte primária de salvaguarda de um património documental inigualável, solidificado pelas personalidades e acontecimentos históricos que imortaliza. A análise da documentação, aqui entendida como elemento construtor de uma memória coletiva e identitária, revelou uma cidade marcada pela emigração para o continente sul americano e a perda de um contingente ativo alargado, pela miséria e pela fome de muitas famílias pertencentes a classes mais pobres, que viam na casa dos hospícios a única salvação para os seus filhos, e uma cidade onde a guerra teve consequências no setor comercial e associativo.

Actinotignum schaalii is a gram-positive, facultative anaerobic bacillus, an opportunist agent that is underestimated or mistaken as a contaminant. In this article, we present a case of sepsis with multiorgan dysfunction due to acute pyelonephritis complicated by A. schaalii bacteraemia in an elderly patient with diabetes mellitus, chronic obstructive renal disease, benign prostatic hyperplasia, renal lithiasis and chronic urinary device. Through specific laboratory techniques such as Matrix-Assisted Laser Desorption/Ionisation Time-Of-Flight Mass Spectrometry, it was possible to identify the presence of A. schaalii in blood cultures. However, uroculture was negative. After 20 days of β-lactam, it was possible to successfully heal the infection. The difficulty in identifying this rare agent has definitely constrained our diagnostic and therapeutic approach.

Numerous studies show efflux as a universal bacterial mechanism contributing to antibiotic resistance and also that the activity of the antibiotics subject to efflux can be enhanced by the combined use of efflux inhibitors. Nevertheless, the contribution of efflux to the overall drug resistance levels of clinical isolates of Mycobacterium tuberculosis is poorly understood and still is ignored by many. Here, we evaluated the contribution of drug efflux plus target-gene mutations to the drug resistance levels in clinical isolates of M. tuberculosis. A panel of 17 M. tuberculosis clinical strains were characterized for drug resistance associated mutations and antibiotic profiles in the presence and absence of efflux inhibitors. The correlation between the effect of the efflux inhibitors and the resistance levels was assessed by quantitative drug susceptibility testing. The bacterial growth/survival vs. growth inhibition was analyzed through the comparison between the time of growth in the presence and absence of an inhibitor. For the same mutation conferring antibiotic resistance, different MICs were observed and the different resistance levels found could be reduced by efflux inhibitors. Although susceptibility was not restored, the results demonstrate the existence of a broad-spectrum synergistic interaction between antibiotics and efflux inhibitors. The existence of efflux activity was confirmed by real-time fluorometry. Moreover, the efflux pump genes mmr, mmpL7, Rv1258c, p55, and efpA were shown to be overexpressed in the presence of antibiotics, demonstrating the contribution of these efflux pumps to the overall resistance phenotype of the M. tuberculosis clinical isolates studied, independently of the genotype of the strains. These results showed that the drug resistance levels of multi- and extensively-drug resistant M. tuberculosis clinical strains are a combination between drug efflux and the presence of target-gene mutations, a reality that is often disregarded by the tuberculosis specialists in favor of the almost undisputed importance of antibiotic target-gene mutations for the resistance in M. tuberculosis.

Sixty-year-old woman, with a history of gastric neoplasia in remission 5 years ago, and since then have a totally iimplantable central venous catheter (TICVC) in the right subclavian vein. No other relevant history and no known allergies.

(1) Background: Membrane lipids have been disregarded in drug development throughout the years. Recently, they gained attention in drug design as targets, but they are still disregarded in the latter stages. Thus, this study aims to highlight the relevance of considering membrane lipids in the preclinical phase of drug development. (2) Methods: The interactions of a drug candidate for clinical use (licofelone) with a membrane model system made of 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) were evaluated by combining Langmuir isotherms, Brewster angle microscopy (BAM), polarization-modulation infrared reflection-absorption spectroscopy (PM-IRRAS), and grazing-incidence X-ray diffraction (GIXD) measurements. (3) Results: Licofelone caused the expansion of the DPPC isotherm without changing the lipid phase transition profile. Moreover, licofelone induced the reduction of DPPC packing density, while increasing the local order of the DPPC acyl chains. (4) Conclusions: The licofelone-induced alterations in the structural organization of phosphatidylcholine monolayers may be related to its pharmacological actions. Thus, the combination of studying drug-membrane interactions with the pharmacological characterization that occurs in the preclinical stage may gather additional information about the mechanisms of action and toxicity of drug candidates. Ultimately, the addition of this innovative step shall improve the success rate of drug development.

Estuaries are highly productive ecosystems that have been increasingly affected by anthropogenic activities. In this study, the presence of endocrine disrupting compounds (EDCs) and their relation to oxidative stress were assessed in two bivalve species (mussels Mytilus galloprovincialis and clams Ruditapes decussatus) from the Ria Formosa Lagoon (south Portugal). We applied the alkali-labile phosphate (ALP) assay to determine vitellogenin-like protein levels, and the lipid peroxidation (LPO) method to assess oxidative damage. Mussels and clams exhibited the same pattern of ALP concentrations, with no differences between genders and higher levels in winter. R. decussatus showed higher ALP values than M. galloprovincialis, possibly associated with a stronger responsiveness of clams to EDCs or due to the influence of the reproductive cycle. Mussels exhibited a more evident seasonal effect for LPO, indicating that these organisms are more influenced by seasonal fluctuations in the water column compared to the sediment-associated clams. Both species appear to be under the influence of EDC exposure (which could induce Vg-like protein synthesis) and oxidative stressors (leading to lipid peroxidation) in the Ria Formosa Lagoon, particularly in winter, reflecting the presence of different contaminants in Ria Formosa and environmental changes, as well as complex interactions between them.

Introdução: Realizar uma análise de custo-efetividade de rituximab no tratamento de manutenção do linfoma folicular após indução em primeira linha, em comparação com observação, em Portugal. Métodos: Desenvolveu-se um modelo de Markov para o linfoma folicular com quatro estados de saúde: sobrevivência livre de progressão, após primeira e segundas linhas, progressão e morte. As probabilidades de transição entre estados de saúde foram obtidas a partir dos ensaios clínicos PRIMA e EORTC20981 e as respetivas utilidades a partir da literatura. A perspetiva da análise foi a do Serviço Nacional de Saúde português e incluiu apenas os custos diretos. O consumo de recursos foi estimado por um painel de peritos constituído por clínicos portugueses. Os custos unitários (€ em 2014) foram estimados usando bases de dados oficiais portuguesas. Realizaram-se análises determinísticas e probabilísticas. Resultados: No cenário base, para um horizonte temporal de dez anos, os custos por ano de vida ganho e por ano de vida ajustado pela qualidade foram de € 10 634 e € 10 664, respetivamente. As análises de sensibilidade confirmaram os resultados do cenário-base para horizontes temporais de 20 e 30 anos, variando entre € 7430 e € 7155. O tratamento de manutenção com rituximab é custo-efetivo para um horizonte temporal de 5,5 anos (custo por ano de vida ajustado pela qualidade ganho de € 23 616). Conclusão: De acordo com o atual modelo, o tratamento de manutenção com rituximab em doentes com linfoma folicular que responderam à terapêutica de indução em primeira linha, em comparação com a observação, é custo-efetivo em Portugal.

Franciscana dolphins were used as source of information on the bioavailability of cadmium in the neritic waters off South Brazilian Coast. Liver samples obtained from 44 individuals incidentally captured off Rio Grande do Sul State were analyzed by electrothermal AAS. Cadmium concentrations, age, total weight and length of the analyzed dolphins varied between 39 and 4144 µg.kg-1 (wet weight), one and five years, 17.5 and 49.2 kg, and between 105.3 and 156.8 cm, respectively. Concerning hepatic cadmium concentrations of franciscanas, there was no significant difference between data raised by the present study and information from literature, regarding Rio de Janeiro State. The low cadmium concentrations observed may be attributed to the fact that loliginid squids constitute the main cephalopod prey for franciscanas. This study corroborates investigations on cadmium levels in Brazilian squids and strengthened the hypothesis that cephalopods of Loliginidae Family do not constitute important vectors of the transfer of cadmium to cetaceans.Franciscanas foram utilizadas como fonte de informação sobre a biodisponibilidade de cádmio em águas neríticas da Costa Sul do Brasil. Amostras de fígado, obtidas de 44 indivíduos capturados acidentalmente ao largo da costa do Rio Grande do Sul, foram analisadas através de EAA eletrotérmica. Concentrações de cádmio, idade, peso e comprimento totais dos golfinhos analisados variaram entre 39 e 4144 µg.kg-1 (peso úmido), um e cinco anos, 17,5 e 49,2 kg, e entre 105,3 e 156,8 cm, respectivamente. Em relação às concentrações hepáticas de cádmio em franciscanas, não houve diferença significativa entre os dados gerados pelo presente estudo e informação proveniente da literatura, referente ao Estado do Rio de Janeiro. As baixas concentrações de cádmio observadas podem ser atribuídas ao fato de as lulas da Família Loliginidae constituírem a principal presa para franciscanas, dentre os cefalópodes. Este estudo corrobora investigações sobre níveis de cádmio em lulas brasileiras e reforça a hipótese de que cefalópodes loliginídeos não constituem vetores importantes da transferência de cádmio para cetáceos.

A propriocetividade, particularmente a perceção da posição relativa dos segmentos anatómicos, sustenta o movimento no meio envolvente (Silva, 2010). Ao permitir uma adequação músculo-esquelética para um movimento harmonioso e equilibrado, ela contribui para a realização das atividades da vida diária (Riemann & Scott, 2002, Huxhan et al, 2001). Associado ao envelhecimento observa-se um declínio da propriocetividade (Skinner et al.1984)A literatura sugere que intervenções centradas em aspetos de programação, controlo, de execução, esquema e equilíbrio corporal, de aprendizagem e experiências contextualizadas (Silva, 2010; Riemann & Scott, 2002) poderão promover ganhos na propriocetividade. Porém conhece-se muito pouco os efeitos de intervenções neuromotoras dirigidas a idosos institucionalizados.Objetivo: Determinar os efeitos de um programa de intervenção neuromotora na propriocetividade de idosos institucionalizados.

As tentativas de suicídio e os comportamentos suicidários representam um problema complexo, com elevada prevalência na adolescência. Estas situações de crise podem ser abordadas em diversos contextos da actividade da Psiquiatria da Infância e da Adolescência, seja no serviço de urgência, na actividade de ligação, ou na consulta de ambulatório. A intervenção na crise suicidária requer o envolvimento tanto do jovem como da família e representa um momento determinante na avaliação clínica e na adesão ao processo terapêutico. No presente artigo é realizada uma revisão sobre os comportamentos suicidários na infância e na adolescência, focando‐se sobre a caracterização dos mesmos e das especificidades ligadas à fase de desenvolvimento, factores de risco e protecção e orientações na avaliação e abordagem terapêutica da crise suicidária em jovens.

Evaluate costs and benefits of rituximab in combination with cyclophosphamide/vincristine/prednisolone chemotherapy regimen (R-CVP), in previously untreated patients with indolent non-Hodgkin lymphoma (NHL), compared to CVP alone from a Portuguese National Health System (NHS) perspective.Cost-effectiveness (Life Years Gained--LYG) and cost-utility analysis (Quality Adjusted Life Years--QALYs) were performed for a time horizon of 10 years, according to a Markov economic model with three health states (progression free survival, progression and death) and monthly cycles for a population of previously untreated patients with indolent NHL. Data from a phase III clinical trial was used and expanded to include unpublished 53-month median follow-up data. Survival after first-line therapy was estimated from the Scotland and Newcastle Lymphoma Group registry data and utilities were derived from a study in the UK performed in patients with follicular lymphoma. Resource consumption was estimated by a Portuguese expert panel (Delbecq Panel). Costs were calculated from the Portuguese NHS perspective through official data with prices updated to 2008. Only direct medical costs were considered. Costs and clinical outcomes were discounted at 5% per annum. Deterministic and probabilistic sensitivity analysis were performed around assumptions on the time horizon, costs, utilities and excess mortality rate due to progression applied in the base-case analysis.The 10-year base-case analysis showed a lower total cost per patient with CVP alone (€ 85,838) in comparison with R-CVP (€ 87,774). Life expectancy and Quality adjusted life expectancy per patient were higher with R-CVP (6.361 and 4.166, respectively) than with CVP alone (5.557 and 3.438, respectively), representing increases of 0.804 in LYG and 0.728 (8.7 months) in QALYs gained. The incremental cost per LYG was € 2,407 and the incremental cost per QALY gained was € 2,661. The probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results.This study demonstrates that the combination R-CVP in previously untreated indolent NHL patients improves life expectancy and is a cost-effective alternative to CVP in Portugal.

Gastric cancer is a highly prevalent disease in Portugal with impact on morbidity and mortality. The approach to a stomach cancer depends on the disease status and prognosis at the time of diagnosis. Surgical resection is the only potentially curative treatment. Up to now, palliative chemotherapy has been the only advantageous therapy option for patients with unresectable advanced gastric cancer or after recurrence, with a median survival of six to nine months. Among the drugs with a known antitumor activity, 5-fluorouracil (5-FU) and cisplatin have been widely used in advanced gastric cancer, either in monotherapy, or in combination. However, 5-FU is administered by intravenous infusion, which requires the insertion of a central venous catheter or the patient's hospitalization and is therefore inconvenient and uncomfortable.Evaluation of the incremental cost in Portugal of using capecitabine as first line treatment in patients with advanced gastric carcinoma as an alternative to 5-FU, both used in association with cisplatin.The study was carried out using the Portuguese National Health Service (NHS) perspective, through an analysis of cost minimization, considering data from a phase III clinical study (ML17032) that demonstrates the non-inferiority of capecitabine versus 5-FU, both in association with cisplatin. A Markov model was developed to evaluate the treatment costs, using a cohort of patients with advanced gastric carcinoma and a timeframe of five cycles. This analysis considered only direct costs.The incremental cost analysis demonstrated savings of 5,868.60 euro per patient with capecitabine therapy (base scenario). The results obtained when considering alternative scenarios (sensitivity analysis), particularly that related to the 5-FU Administration method, reinforce the base scenario savings result.The analysis conducted demonstrated that the use of capecitabine+cisplatin (CAP-cis) allows a cost reduction when compared to the alternative 5-FU+cisplatin (5-FU-cis). Capecitabine clinical efficacy is not inferior to 5-FU and it has a more convenient and comfortable administration method. It also eliminates the risk of complications associated with intravenous perfusion, consequently reducing the need for hospitalisation. The replacement of 5-FU with capecitabine is shown to be economically advantageous.

Objetivou-se identificar as especialidades mais desejadas pelos alunos de Medicina do Centro Universitário do Estado do Pará (Cesupa) e fatores determinantes dessa escolha. Trata-se de um estudo transversal, descritivo e analítico, realizado mediante aplicação de questionários a alunos do primeiro, quarto e sexto anos, no período de novembro de 2012 a março de 2013. A maioria dos alunos era do sexo masculino (59,2%), com média de idade de 22 ± 2 anos, possuindo renda familiar acima de dez salários mínimos e apresentando pelo menos um parente médico. As principais especialidades escolhidas foram: Cirurgia Plástica (10,4%), Endocrinologia (15,7%), e Oftalmologia (14,0%) no primeiro, quarto e sexto anos, respectivamente. O principal fator influenciador na escolha no primeiro ano foi a influência dos pais (17,2%), e no quarto e sexto anos o fator financeiro, com 15,8% e 22,8%, respectivamente. Conclui-se que muitos fatores influenciam a escolha de especialidades, sendo necessário buscar formas de atrair alunos para áreas de caráter mais generalista.