Browsing by Author "Nunes, B"
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- Cross-Protection to New Drifted Influenza A(H3) Viruses and Prevalence of Protective Antibodies to Seasonal Influenza, During 2014 in PortugalPublication . Guiomar, R; Pereira da Silva, S; Conde, P; Cristóvão, P; Maia, AC; Pechirra, P; Rodrigues, AP; Nunes, B; Milho, L; Coelho, AP; Fernandes, A; Caseiro, P; Rodrigues, F; Correia, L; Pereira-Vaz, J; Almeida, S; Branquinho, P; Côrte-Real, R; Viseu, R; Peres, MJ; Sanches, R; Dantas, F; Freitas, L; Andrade, G; Maurílio, M; Caldeira, F; Cabral Veloso, R; Mota-Vieira, L; Soares, M; Couto, AR; Bruges-Armas, J; Mouro Pinto, R; Sobrinho Simões, J; Costa, MR; Guimarães, JT; Martins, L; Cunha, MINTRODUCTION: Immune profile for influenza viruses is highly changeable over time. Serological studies can assess the prevalence of influenza, estimate the risk of infection, highlight asymptomatic infection rate and can also provide data on vaccine coverage. The aims of the study were to evaluate pre-existing cross-protection against influenza A(H3) drift viruses and to assess influenza immunity in the Portuguese population. MATERIALS AND METHODS: We developed a cross-sectional study based on a convenience sample of 626 sera collected during June 2014, covering all age groups, both gender and all administrative health regions of Portugal. Sera antibody titers for seasonal and new A(H3) drift influenza virus were evaluated by hemagglutination inhibition assay (HI). Seroprevalence to each seasonal influenza vaccine strain virus and to the new A(H3) drift circulating strain was estimated by age group, gender and region and compared with seasonal influenza-like illness (ILI) incidence rates before and after the study period. RESULTS: Our findings suggest that seroprevalences of influenza A(H3) (39.9%; 95% CI: 36.2-43.8) and A(H1)pdm09 (29.7%; 95% CI: 26.3-33.4) antibodies were higher than for influenza B, in line with high ILI incidence rates for A(H3) followed by A(H1)pdm09, during 2013/2014 season. Low pre-existing cross-protection against new A(H3) drift viruses were observed in A(H3) seropositive individuals (46%). Both against influenza A(H1)pdm09 and A(H3) seroprotection was highest in younger than 14-years old. Protective antibodies against influenza B were highest in those older than 65years old, especially for B/Yamagata lineage, 33.3% (95% CI: 25.7-41.9). Women showed a high seroprevalence to influenza, although without statistical significance, when compared to men. A significant decreasing trend in seroprotection from north to south regions of Portugal mainland was observed. CONCLUSIONS: Our results emphasize that low seroprotection increases the risk of influenza infection in the following winter season. Seroepidemiological studies can inform policy makers on the need for vaccination and additional preventive measures.
- O Impacto das Ferramentas Digitais no Tratamento da Insónia, uma Revisão Baseada na EvidênciaPublication . Nunes, B; Nunes Rodrigues, R; Resende, SIntrodução: Em Portugal, a insónia tem uma prevalência estimada de 10%. O tratamento de primeira linha é a terapia cognitivo-comportamental dirigida à insónia (TCC-I), no entanto há escassez de terapeutas disponíveis. O objetivo desta revisão baseada na evidência foi averiguar a eficácia das TCC-I através de meios digitais (TCC-ID) em adultos. Métodos: Foi realizada pesquisa de metanálises, metanálises em rede (MAR), revisões sistemáticas, ensaios clínicos randomizados (ECR) e normas de orientação clínica, publicados entre janeiro de 2018 e dezembro de 2022. Termos MeSH: “cognitive behavioural therapy”, “insomnia disorder”, “telemedicine” e “digital technology”. Fontes de dados: Cochrane Library, DARE, NICE, Direção-Geral de Saúde, Google Scholar e PubMed. Resultados: Foram obtidos 101 artigos e selecionados uma MAR e três ECR. A TCC-ID (Somryst®) apresenta uma probabilidade de 56% de ser o tratamento mais eficaz na insónia e uma probabilidade de 64% de ser o tratamento mais eficaz na sua remissão às 6 a 12 semanas. Em grávidas com insónia, a TCC-ID (Sleepio®) apresenta uma redução superior do score Índice de Severidade da Insónia (ISI) comparativamente com as terapias convencionais (p = 0,08). As taxas de remissão de insónia aos seis meses pós-parto foram superiores no grupo da TCC-ID (p = 0,02). Verificou-se uma melhoria no score ISI às 4 semanas (p = 0,063) após TCC-ID (StudiCare Sleep-e®) e às 12 semanas a diferença tornou-se estatisticamente significativa (p < 0,001). Tanto a TCC-I como TCC-ID apresentam impacto positivo na gravidade dos sintomas de insónia. No grupo que recebeu TCC-ID (WeChat®), houve uma melhoria estatisticamente significativa do score Pittsburgh Sleep Quality Index (p < 0,001). Discussão: A evidência demonstra não inferioridade entre TCC-ID e TCC-I convencional em adultos. A presente revisão apresenta limitações: amostra pouco heterogénea e inclusão de aplicações em língua estrangeira. Conclusão: A TCC-ID pode ser recomendada como alternativa à TCC-I convencional (Strength of Recommendation Taxonomy A).
- Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital ProjectPublication . Machado, A; Gomez, V; Panarra, A; Poças, J; Corte-Real, R; Peres, MJ; Nunes, BIntroduction: The project ‘Integrated Monitoring of Vaccines in Europe’ aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 – odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month. Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.
- Improving Influenza Surveillance in Portuguese Preschool Children by Parents' ReportPublication . Paixão, P; Piedade, C; Papoila, AL; Caires, I; Pedro, C; Santos, M; Silvestre, MJ; Brum, L; Nunes, B; Guiomar, R; Curran, M; Carvalho, A; Marques, T; Neuparth, NInfluenza surveillance is usually based on nationally organized sentinel networks of physicians and on hospital reports. This study aimed to test a different report system, based on parents' phone contact to the research team and in home collection of samples by a dedicated team. The identification of influenza and other respiratory viruses in children who attended a Hospital Emergency Department was also recorded. Real-time PCR and reverse transcription PCR were performed for influenza A and B, parainfluenza 1-4, adenovirus, human metapneumovirus, respiratory syncytial virus A and B, rhinovirus, enterovirus, group 1 coronaviruses, group 2 coronaviruses, and human bocavirus. One hundred children were included, 64 from the day care centers and 36 from the Hospital. Overall, 79 samples were positive for at least one respiratory virus. Influenza A (H3) was the virus most frequently detected: 25 cases, 20 of these in children under 5 years of age (ten from day care centers and ten who went to the hospital) which was higher than those reported by the National Influenza Surveillance Programme for this age. CONCLUSION: The results obtained in this study suggest that a surveillance system based on parents' reports could complement the implanted system of the National Influenza Surveillance Programme.
- Population Genetics of IFITM3 in Portugal and Central Africa Reveals a Potential Modifier of Influenza SeverityPublication . David, S; Correia, V; Antunes, L; Faria, R; Ferrão, J; Faustino, P; Nunes, B; Maltez, F; Lavinha, J; Rebelo de Andrade, HInfluenza epidemics are a serious global public health and economic problem. The IFITM3 allele (rs12252-C) was suggested as a population-based genetic risk factor for severe influenza virus infection by A(H1N1)pdm09. We analyzed the population genetics of IFITM3 variants in the Portuguese general population (n = 200) and Central Africans (largely Angolan) (n = 148) as well as its association to influenza severity in Portuguese patients (n = 41). Seven SNPs, within the 352 bp IFITM3 amplicon around rs12252, were identified. SNP distributions in the Portuguese appeared at an intermediate level between the Africans and other Europeans. According to HapMap, rs34481144 belongs to the same linkage disequilibrium (LD) block as rs12252 and is in strong LD with rs6421983. A negative association with severe relative to mild disease was observed for allele rs34481144-A, indicating a protective effect under the dominant model. Moreover, haplotype Hap4 with rs34481144-A, not including rs12252-C, was significantly associated to mild influenza. Conversely, although with borderline significance, haplotype Hap1 with rs34481144-G, not including rs12252-C, was associated to severe disease. Moreover, in comparison to the general Portuguese population, statistical significant differences in the frequencies of the protective allele rs34481144-A in the severe disease group, the deleterious Hap1 in the mild disease group, and the protective Hap4 in the severe disease group were observed. The population attributable risk (PAR) for the targeted rs34481144 allele or genotype was of 55.91 and 64.44% in the general population and the mildly infected individuals, respectively. Implication of these variants in disease phenotype needs further validation, namely through functional analysis as is discussed.
- Varicela ou Herpes Zoster em Crianças InternadasPublication . Leça, A; Branco, MJ; Brito, MJ; Gouveia, C; Farela Neves, J; Nunes, B