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Silva S.M.,University of Porto | Silva S.M.,Center for Health Technology and Services Research | Cunha-Cabral D.,University of Porto | Andrade J.P.,University of Porto | Andrade J.P.,Center for Health Technology and Services Research
Clinical Neurology and Neurosurgery | Year: 2017

Objective The Klingler fiber dissection technique is a relevant and reliable method for neurosurgery to identify with accuracy the fine structure of the brain anatomy highlighting white matter tracts. In order to demonstrate the significance of the application of this technique, we aimed to observe the course and relations of the mammillothalamic and habenulo-interpeduncular tracts as there are very few papers showing these important diencephalic tracts. Material and methods Twelve formalin-fixed brains were dissected using the Klingler technique in order to expose the medial diencephalic surface. Diencephalic white matter tracts, particularly the mammillothalamic and habenulo-interpeduncular tracts, were dissected using wooden spatulas and metallic dissectors with different sizes and tips. Several measurements were performed in both dissected hemispheres relative to the mammillothalamic and habenulo-interpeduncular tracts. Results The course and length of these two tracts were visualized and the relations with other fiber systems and with the neighboring gray matter structures quantified and registered. The mammillothalamic tract approximately marks the anteroposterior coordinate of the anterior pole of the subthalamic nucleus in the anterior commissure – posterior commissure plane. Conclusion The present study helps to understand the three-dimensional architecture of the white matter systems of tracts when the Klingler technique is used. The numerical data obtained may be helpful to neurosurgeons while approaching brain paraventricular and ventricular lesions and deep brain stimulation. Finally, the anatomical knowledge can lower surgical complications and improve patient care particularly in the field of neurosurgery. © 2017 Elsevier B.V.


Martins I.,University of Porto | Carvalho P.,University of Porto | De Vries M.G.,University of Groningen | De Vries M.G.,Brains On Line BV | And 6 more authors.
Pain | Year: 2015

The dorsal reticular nucleus (DRt) plays a key role in facilitation of nociceptive transmission at the spinal cord. In this study, we evaluated the mechanisms involved in GABA-mediated control of the DRt focusing on the role of local GABAB receptors. First, we used in vivo microdialysis to study the release of GABA in the DRt during the course of the formalin test. An increase of GABA levels in comparison with baseline values was detected in the second phase of the test. Because we previously showed that GABAB receptors are expressed by opioidergic DRt neurons, which respond to nociceptive stimuli and inhibit spinally projecting DRt neurons involved in descending pronociception, we then interfered with local GABAB receptors using gene transfer and pharmacological approaches. Lentiviral-mediated knockdown of GABAB1a expression decreased nociceptive responses during the second phase of the test. Local administration of the GABAB receptor antagonist CGP 35348 also decreased nociceptive responses in the second phase of the test, whereas the opposite was detected after injection of the GABAB agonist baclofen. Finally, we determined the GABAergic afferents of the DRt, namely those arising from its main brain afferents, which are located at the telencephalon and diencephalon. For that purpose, we combined retrograde tract-tracing from the DRt with immunodetection of glutamate decarboxylase, the GABA-synthesizing enzyme. The higher numbers of retrogradely labelled glutamate decarboxylase-immunoreactive neurons were located at insular, somatosensory, and motor cortices. Collectively, the results suggest that GABA acting on GABAB receptors may enhance pain facilitation from the DRt during inflammatory pain. © 2015 International Association for the Study of Pain.


Martinho R.,Polytechnic Institute of Leiria | Martinho R.,Center for Health Technology and Services Research | Domingos D.,University of Lisbon | Varajao J.,University of Minho
Procedia Computer Science | Year: 2015

The need for flexibility in business process languages and tools has evolved over the past few decades, from totally rigid approaches, to totally flexible ones. The need to allow process designers to control this flexibility has risen due to the fact that, in the everyday practice, people do not wish for total flexibility. They rather prefer to be guided, even when they feel the need to change some part of business process. In this paper we propose CF4BPMN, a BPMN language extension to allow modeling and execution of controlled flexibility in business processes. Using this extension, process designers can express how a certain process element can or cannot be changed in execution time, taking into account their experience or other organizational restriction. Then, other process participants can visually learn and follow the advised changes onto a business process in a controlled manner. © 2015 The Authors. Published by Elsevier B.V.


Silva A.G.,University of Aveiro | Silva A.G.,Center for Health Technology and Services Research | Queiros A.,University of Aveiro | Alvarelhao J.,University of Aveiro | Rocha N.P.,University of Aveiro
International Journal of Therapy and Rehabilitation | Year: 2014

Aim: To translate and validate a European Portuguese version of the Rapid Assessment of Physical Activity (RAPA) questionnaire.Methods: The original English version of RAPA was translated into Portuguese following standardized procedures. Fifty-five Portuguese older adults were assessed in two sessions, approximately one week apart. Test-retest reliability was evaluated by weighted kappa (K). Construct validity was evaluated by Spearman’s correlation coefficient between the RAPA and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the short physical performance battery (SPPB) (gait and chair stands tests, and total score); and by the Mann-Whitney U test between participants with and without depression and able and unable to complete the SPPB balance test.Results: Weighted K was 0.67 (95% CI=0.52–0.81) for reliability. A significant correlation was found between the RAPA and WHODAS 2.0 (rs=–0.47, p<0.01), gait test (rs=–0.45, p<0.01) and total SPPB score (rs=0.45, p<0.01). Participants able to complete the SPPB balance test had higher levels of physical activity than those unable (3.25±1.23 vs 2.37±1.30, p<0.05), and those without depression had higher levels of physical activity than those with depression (3.24±1.23 vs 2.50±1.34, p<0.05).Conclusions: The European Portuguese version of the RAPA questionnaire seems valid. However, its reliability requires further investigation. © 2014 MA Healthcare Ltd.


Silva S.M.,University of Porto | Silva S.M.,Center for Health Technology and Services Research | Andrade J.P.,University of Porto | Andrade J.P.,Center for Health Technology and Services Research
Annals of Anatomy | Year: 2016

Undergraduate neuroanatomy students are usually not able to achieve a clear comprehension of the spatial relationships existing between the white matter fiber tracts in spite of numerous neuroanatomy textbooks, atlases and multimedia tools.The objective of this paper is to show the educational value of the application of the Klingler fiber dissection technique and the use of these dissections in the understanding of the three-dimensional intrinsic anatomy of the brain white matter for medical students.Four formalin-fixed brains were dissected using the Klingler methodology in order to reveal the inner anatomical organization of the brain white matter. The most important fiber systems were dissected and their relationships to the cerebral and cerebellar gray matter structures visualized. These dissections were used as a learning tool in teaching the brain white matter structural and topographical connectivity. The white matter fiber systems were presented to undergraduate medical students during a neuroanatomy course. They observed and manipulated the dissected specimens leading to a thorough understanding of the configuration and location of the white matter fiber tracts, and their relationships to the ventricular system and gray matter structures. Subsequently, students were asked to answer a survey concerning the importance of the utilization of this material in their understanding of the three-dimensional intrinsic anatomy of the brain white matter. The knowledge acquired with this technique, complemented by conventional formalin-fixed sections may improve the neuroanatomical knowledge and future retention of medical students. © 2016 Elsevier GmbH.


Serrano M.,Portuguese Oncology Institute | Kikuste I.,University of Latvia | Kikuste I.,Digestive Diseases Center | Dinis-Ribeiro M.,Center for Health Technology and Services Research | Dinis-Ribeiro M.,Portuguese Oncology Institute
Best Practice and Research: Clinical Gastroenterology | Year: 2014

The most immediate strategy for improving survival of gastric cancer patients is secondary prevention through diagnosis of early gastric cancer either through screening or follow-up of individuals at high risk. Endoscopy examination is therefore of paramount importance and two general steps are to be known in assessing gastric mucosa - detection and characterization. Over the past decade, the advent of advanced endoscopic imaging technology led to diverse descriptions of these modalities reporting them to be useful in this setting. In this review, we aim at summarizing the current evidence on the use of advance imaging in individuals at high-risk (i.e., advance stages of gastric atrophy/intestinal metaplasia) and in those harbouring neoplastic lesions, and address its potential usefulness providing the readers a framework to use in daily practice. Further research is also suggested. © 2014 Elsevier Ltd. All rights reserved.


Cruz J.,University of Aveiro | Brooks D.,University of Toronto | Marques A.,University of Aveiro | Marques A.,Center for Health Technology and Services Research
Chronic Respiratory Disease | Year: 2014

This study aimed at investigating whether providing feedback on physical activity (PA) levels to patients with chronic obstructive pulmonary disease (COPD) is feasible and enhances daily PA during pulmonary rehabilitation (PR). Patients with COPD participated in a 12-week PR program. Daily PA was measured using activity monitors on weeks 1, 7, and 12, and feedback was given in the following weeks on the number of steps, time spent in sedentary, light, and moderate-to-vigorous intensity activities, and time spent standing, sitting, and lying. Compliance with PA monitoring was collected. Two focus groups were conducted to obtain patients' perspectives on the use of activity monitors and on the feedback given. Differences in PA data were also assessed. Sixteen patients (65.63 ± 10.57 years; forced expiratory volume in one second (FEV1) 70.31 ± 22.74% predicted) completed the study. From those, only eleven participants used the activity monitors during all monitoring days. Participants identified several problems regarding the use of activity monitors and monitoring duration. Daily steps (p = 0.026) and standing time (p = 0.030) were improved from week 1 to week 7; however, the former declined from week 7 to week 12. Findings suggest that using feedback to improve PA during PR is feasible and results in improved daily steps and standing time on week 7. The subsequent decline suggests that additional strategies may be needed to stimulate/maintain PA improvements. Further research with more robust designs is needed to investigate the impact of feedback on patients' daily PA. © The Author(s) 2014.


PubMed | Center for Health Technology and Services Research, University of Porto and Hospital Nelio Mendonca
Type: | Journal: BMC pregnancy and childbirth | Year: 2015

Misinterpretation of the maternal heart rate (MHR) as fetal may lead to significant errors in fetal heart rate (FHR) interpretation. In this study we hypothesized that the removal of these MHR-FHR ambiguities would improve FHR analysis during the final hour of labor.Sixty-one MHR and FHR recordings were simultaneously acquired in the final hour of labor. Removal of MHR-FHR ambiguities was performed by subtracting MHR signals from their FHR counterparts when the absolute difference between the two was less or equal to 5 beats per minute. Major MHR-FHR ambiguities were defined when they exceeded 1% of the tracing. Maternal, fetal and neonatal characteristics were evaluated in cases where major MHR-FHR ambiguities occurred and computer analysis of FHR recordings was compared, before and after removal of the ambiguities.Seventy-two percent of tracings (44/61) exhibited episodes of major MHR-FHR ambiguities, which were not significantly associated with any maternal, fetal or neonatal characteristics, but were associated with MHR accelerations, FHR signal loss and decelerations. Removal of MHR-FHR ambiguities resulted in a significant decrease in FHR decelerations, and improvement in FHR tracing classification.FHR interpretation during the final hour of labor can be significantly improved by the removal of MHR-FHR ambiguities.


PubMed | University of Porto and Center for Health Technology and Services Research
Type: Journal Article | Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology | Year: 2016

Although several studies have reported an increase of syphilis incidence over the last decade in Western Europe, information concerning syphilis epidemiology in Portugal remains scarce. Therefore, we sought to characterise acquired syphilis-associated hospitalisations in Portugal according to demographic and clinical data. We used a database containing all hospitalisations that occurred in mainland Portugal public hospitals with discharges between 2000 and 2014. We analysed all hospitalisations associated with ICD-9-CM codes 091-097.x (corresponding to acquired syphilis diagnosis) concerning inpatients gender, age and comorbidities. The median length of stay and in-hospital mortality rates were also studied. Between 2000 and 2014, there were a total of 8974 syphilis-related hospitalisations in mainland Portugal. The rate of acquired syphilis hospitalisations per 100,000 inhabitants increased by 33 % during the studied period. Syphilis hospitalisation rates increased by 70 % in males and 139 % among patients aged over 55 years. On the other hand, they declined by 10 % in females and 20 % among patients younger than 55 years old. The percentage of syphilis episodes presenting cardiovascular and neuropsychiatric comorbidities increased, while the percentage of syphilis episodes presenting HIV co-infection decreased by 69 %. A fatal outcome was reported in 5 % of episodes; 4.6 % of them had acquired syphilis as the main reason for hospitalisation. This study illustrates that, despite being a preventable infection, syphilis remains a public health problem. The analysis of hospitalisation and administrative data helps to understand syphilis epidemiology and provides a supplement to traditional case notifications.


PubMed | Center for Health Technology and Services Research
Type: Journal Article | Journal: Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP) | Year: 2015

Studies on the late acquisition of morphosyntax in European Portuguese (EP)-speaking children are relatively scarce in the literature. The purpose of this paper is to report data on the morphosyntactic domain from typically developing children. The present investigation focused on differences in morphosyntactic performance according to specific demographic variables (e.g., gender, age, ecological setting, and socioeconomic background).Eighty EP-speaking children aged between 6 years and 6 years and 11 months were assessed with the Language Test - Preschool Language Assessment (TL-ALPE).Within the age range considered, some receptive and productive competencies were acquired. Significant differences were found for gender and age.These outcomes contribute to the knowledge of late developmental processes in the morphosyntactic domain, in EP-speaking children, presenting well-established performance standards. The provided reference information is fundamental to accurately identify children with language impairment and to construct new valid assessment instruments.

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