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Romão VC, Ávila-Ribeiro P, Gonçalves MJ, Cruz-Machado R, Guerreiro AB, Teixeira V, Valido A, Silva-Dinis J, Vieira-Sousa E, Saavedra MJ, Sacadura-Leite E, Marinho RT, Fonseca JE. Hepatitis B vaccination associated with low response in patients with rheumatic diseases treated with biologics. RMD Open 2023; 9:e003597. [PMID: 38056920 PMCID: PMC10711851 DOI: 10.1136/rmdopen-2023-003597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) vaccination is recommended for non-immunised patients with rheumatic diseases starting biological disease-modifying antirheumatic drugs (bDMARDs). There is some evidence that HBV vaccination is effective in patients under conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), but it is currently unclear whether this also applies to bDMARDs. OBJECTIVES To assess the efficacy and safety of HBV vaccination in patients with inflammatory arthritides treated with bDMARDs. METHODS A prospective cohort with inflammatory arthritides treated with bDMARDs, negative for anti-HBs and anti-HBc and never vaccinated for HBV was recruited. Engerix B was administered at 0, 1 and 6 months and anti-HBs was reassessed ≥1 month after last dose. Response was defined as anti-HBs≥10 IU/L and compared against vaccinated healthy controls. Disease flare, serious adverse events and immune-related disorders not previously present were recorded. RESULTS 62 patients, most treated with TNF inhibitors (TNFi), and 38 controls were recruited. Most patients were taking csDMARDs (67.7%) and were in remission/low disease activity (59.4%). Only 20/62 patients (32.3%) had a positive response to vaccination, in comparison to 36/38 age-matched controls (94.7%, p<0.001). Response was seen in 19/51 patients treated with TNFi (37.3%) and in 1/11 (9.1%) patients treated with non-TNFi (p=0.07), including 1/6 treated with tocilizumab (16.7%). Among TNFi, response rates ranged from 4/22 (18.2%) for infliximab to 8/14 (57.1%) for etanercept. No relevant safety issues were identified. CONCLUSIONS HBV vaccination response in patients with rheumatic diseases treated with bDMARDs was poorer than expected. Our data reinforce the recommendation for vaccination prior to starting bDMARDs.
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Affiliation(s)
- Vasco C Romão
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Pedro Ávila-Ribeiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Maria João Gonçalves
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Rita Cruz-Machado
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - André Bento Guerreiro
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Vítor Teixeira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Serviço de Reumatologia, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana Valido
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Joana Silva-Dinis
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Elsa Vieira-Sousa
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
| | - Maria João Saavedra
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Ema Sacadura-Leite
- Occupational Health Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Rui Tato Marinho
- Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - João Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Unidade de Investigação em Reumatologia, Universidade de Lisboa Instituto de Medicina Molecular João Lobo Antunes, Lisboa, Portugal
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Henriques M, Soares P, Sacadura-Leite E. Vitamin D levels in Portuguese military personnel. BMJ Mil Health 2023; 169:542-547. [PMID: 35236767 DOI: 10.1136/bmjmilitary-2021-002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In Portugal, most adults have inadequate levels of vitamin D. Active duty military personnel need to be always ready for duty, perform tasks in specific contexts and overcome high physical and mental demands, which raises the relevance of knowing their vitamin D levels. This study aims to characterise vitamin D levels of Portuguese active duty military personnel and evaluate the effect of military status on the prevalence of vitamin D sufficiency, adjusted for season of the year, age and gender. METHODS A retrospective cross-sectional study, based on vitamin D measurements carried out at the Armed Forces Hospital between 2014 and 2020, was fulfilled including the variables age, gender, vitamin D level and dosing date for military personnel and civilians. Comparison of proportions test and the generalised linear regression model were used for data analysis with a significance level of 5%. RESULTS Out of 2782 subjects, 62.7% were military personnel. Mean±SD level of vitamin D was 24.5±10.6 ng/mL and 23.7±11.5 ng/mL in military personnel and civilians, respectively. In the military personnel, the prevalence of vitamin D sufficiency, insufficiency and deficiency was, respectively, 25.2%, 40.1% and 34.6%. Prevalence of vitamin D sufficiency was similar in the civilians cohort and, also, between Armed Forces branches. Military status had no effect on the prevalence of vitamin D sufficiency, especially after adjustments. CONCLUSIONS We present data on vitamin D levels of Portuguese active duty military personnel. Our results found that military personnel are no more at risk of vitamin D inadequacy than civilians, but only a quarter of active duty military personnel had vitamin D sufficiency. Therefore, they can benefit from vitamin D levels assessment towards vitamin D levels optimisation. Further studies are still needed, especially among military personnel with higher risk of vitamin D deficiency.
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Affiliation(s)
- Moisés Henriques
- Naval Research Centre (CINAV), Naval School, Almada, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
| | - P Soares
- Public Health Investigation Centre, National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal
| | - E Sacadura-Leite
- Public Health Investigation Centre, National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
- Institute for Preventive Medicine and Public Health, University of Lisbon Medical Faculty, Lisboa, Portugal
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Antao HS, Sacadura-Leite E, Bandarra NM, Figueira ML. Omega-3 index as risk factor in psychiatric diseases: a narrative review. Front Psychiatry 2023; 14:1200403. [PMID: 37575565 PMCID: PMC10416246 DOI: 10.3389/fpsyt.2023.1200403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Numerous studies have described associations between the omega-3 index (defined as the RBC percentage of EPA and DHA) and mental conditions, but no risk stratification or target value has gathered consensus so far. This narrative review aims to summarize the published data on the association between omega-3 index and mental illness and to contribute to the concept of an omega-3 index in the field of mental health. The bibliographic searches have been carried out in PubMed, Scopus and Web of Science databases to find relevant English language original research studies related to that association. The study search and selection process were registered in a PRISMA flow. Thirty-six studies were included in this review examining the links between omega-3 index and postpartum depression (3), major depression (15), major depression and bipolar disorder (1), bipolar disorder (4), schizophrenia and major depression (1), schizophrenia and other psychosis (5) and dementia (7). Thirty of these studies found either significant differences in omega-3 index between patients and controls or inverse relationships between omega-3 index and disease severity. The published evidence is compelling enough to suggest omega-3 index as a risk factor for some psychiatric diseases, specifically, major depression, postpartum depression, psychosis, and dementia. In occidental populations, we propose a risk threshold of (a) 4-5% in major depression and dementia, (b) 5% in postpartum depression, and (c) 4% for psychosis transition.
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Affiliation(s)
| | - Ema Sacadura-Leite
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- CISP – Centro de Investigação em Saúde Pública, ENSP, Lisbon, Portugal
- Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal
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Henriques M, Rodrigues D, Viegas S, Serranheira F, Sacadura-Leite E. Vitamin D status in active duty Navy military personnel: a systematic review. Occup Environ Med 2023; 80:353-360. [PMID: 37012046 DOI: 10.1136/oemed-2022-108710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/17/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Active duty Navy military personnel are prone to vitamin D deficiency due to an occupational environment detrimental to sunlight exposure. The main objective of this systematic review is to provide a worldwide overview of vitamin D status in this population. METHODS The Condition, Context, Population (CoCoPop) mnemonic was used to define the inclusion criteria (vitamin D status; all contexts; active duty Navy military personnel). Studies with recruits or veterans were excluded. Scopus, Web of Science and PubMed/Medline databases were searched from inception to 30 June 2022. Joanna Briggs Institute and Downs & Black checklists were used for quality assessment and data were synthesised in narrative and tabular formats. RESULTS Thirteen studies published between 1975 and 2022 and conducted in northern hemisphere Navies, including mainly young and male service members, were included. The prevalence of vitamin D deficiency was globally reported as significant. Nine studies included a total of 305 male submariners who performed 30-92 days submarine patrol and reported the effect of sunlight deprivation in the decrease of vitamin D levels. CONCLUSIONS This new systematic review underlines the high prevalence of vitamin D deficiency in the Navy, especially in submariners, and the need to implement measures to prevent vitamin D deficiency. Serum 25(OH)D data available and the heterogeneity of the studies limited a pooled analysis. Most studies included only submariners, which may limit generalisability to all active duty Navy military personnel. Further research on this topic should be promoted. PROSPERO REGISTRATION NUMBER CRD42022287057.
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Affiliation(s)
- Moisés Henriques
- Portuguese Navy Research Centre (CINAV), Portuguese Navy, Almada, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre (CHRC), NOVA University Lisbon, Lisbon, Portugal
| | - Diogo Rodrigues
- Portuguese Navy Research Centre (CINAV), Portuguese Navy, Almada, Portugal
| | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre (CHRC), NOVA University Lisbon, Lisbon, Portugal
| | - Florentino Serranheira
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre (CHRC), NOVA University Lisbon, Lisbon, Portugal
| | - Ema Sacadura-Leite
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre (CHRC), NOVA University Lisbon, Lisbon, Portugal
- Occupational Health Department, Northern Lisbon University Hospital Centre, Lisbon, Portugal
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Antao HS, Sacadura-Leite E, Correia AI, Figueira ML. Burnout in hospital healthcare workers after the second COVID-19 wave: Job tenure as a potential protective factor. Front Psychol 2022; 13:942727. [PMID: 36003097 PMCID: PMC9393520 DOI: 10.3389/fpsyg.2022.942727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Burnout is an impactful occupational health phenomenon to which doctors and nurses have been more exposed during the COVID-19 pandemic. The objectives of this study were to measure the dimensions of burnout-emotional exhaustion, depersonalization and personal accomplishment-in a hospital healthcare population after the second COVID-19 wave and to study their association with sociodemographic variables and previous COVID-19 infection. We invited 112 healthcare professionals (doctors and nurses) who attended the occupational health department of a tertiary hospital in March-July 2021. Emotional exhaustion, depersonalization and personal accomplishment were measured by the Maslach Burnout Inventory. Linear-regression analyses were conducted to explore relationships between burnout dimensions and sociodemographic variables. Differences between groups according to previous COVID-19 infection were verified using the t-test and when appropriate the Mann-Whitney test (for continuous variables), the chi-square test and when appropriate the Fisher exact test (for categorical variables). We surveyed 106 subjects (95% response rate). High emotional exhaustion and depersonalization were reported by 33.0 and 18.4% of participants, respectively; 21.4% reported low personal accomplishment. Job tenure was associated with depersonalization and personal accomplishment. For each 1-year increase in job tenure, depersonalization decreases 0.14 (95% CI [-0.23, -0.04]) and personal accomplishment increases 0.16 (95% CI [0.06, 0.25]). Gender was associated with emotional exhaustion (being male increases emotional exhaustion 5.62-fold [95% CI: 1.33; 9.92]). The prevalence of high emotional exhaustion, high depersonalization and low personal accomplishment after the second COVID-19 wave was relevant and should not be overlooked. Our findings suggest that job tenure may play a protective role in healthcare workers' burnout.
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Affiliation(s)
- Helena Sofia Antao
- Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ema Sacadura-Leite
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Departamento de Saúde Ocupacional, Centro Hospitalar e Universitário de Lisboa Norte, Lisbon, Portugal
- CISP - Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Lisbon, Portugal
| | - Ana Isabel Correia
- Departamento de Saúde Ocupacional, Centro Hospitalar e Universitário de Lisboa Norte, Lisbon, Portugal
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Henriques M, Rodrigues D, Sacadura-Leite E, Viegas S, Serranheira F. Vitamin D status in the active duty Navy military personnel: protocol for a systematic review. BMJ Open 2022; 12:e060876. [PMID: 35613805 PMCID: PMC9174767 DOI: 10.1136/bmjopen-2022-060876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Vitamin D is critical for bone health and its deficiency has been linked to increased incidence and severity of multiple diseases. Even so, vitamin D inadequacy is a major public health problem worldwide. The main source of vitamin D is endogenous cutaneous synthesis through exposure to solar ultraviolet B radiation, which is influenced by several factors, including occupational. The active duty Navy military personnel may be prone to vitamin D inadequacy, but a worldwide overview of vitamin D status in this specific population is still lacking. METHODS AND ANALYSIS The CoCoPop mnemonic will be used for determining the inclusion criteria. Scopus, Web of Science and PubMed/Medline will be searched for all studies including 25-hydroxyvitamin D concentrations of the active duty Navy military personnel. Data extraction and quality assessment (Joanna Briggs Institute's and Downs and Black checklists) will be performed by two reviewers and data will be synthesised in narrative, tabular and map formats. ETHICS AND DISSEMINATION This study will not involve human or animal subjects and, thus, does not require ethics approval. The outcomes will be disseminated via publication in a peer-reviewed scientific journal and presentation at a scientific conference. PROSPERO REGISTRATION NUMBER CRD42022287057.
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Affiliation(s)
- Moisés Henriques
- Portuguese Navy Research Centre (CINAV), Portuguese Naval Academy, Portuguese Military University Institute (IUM), Almada, Portugal
- Public Health Research Centre, NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Diogo Rodrigues
- Portuguese Navy Research Centre (CINAV), Portuguese Naval Academy, Portuguese Military University Institute (IUM), Almada, Portugal
| | - Ema Sacadura-Leite
- Public Health Research Centre, NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susana Viegas
- Public Health Research Centre, NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Florentino Serranheira
- Public Health Research Centre, NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
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Henriques M, Sacadura-Leite E. [Food Fortification with Vitamin D in Portugal]. ACTA MEDICA PORT 2022; 35:73-74. [PMID: 35225765 DOI: 10.20344/amp.17420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Moisés Henriques
- Centro de Investigação Naval. Escola Naval. Almada; Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Ema Sacadura-Leite
- Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Serviço de Saúde Ocupacional. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Instituto de Medicina Preventiva. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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Santos C, Dixe MDA, Sacadura-Leite E, Astoul P, Sousa-Uva A. Asbestos Exposure and Malignant Pleural Mesothelioma: A Systematic Review of Literature. Port J Public Health 2022. [DOI: 10.1159/000527971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
<b><i>Background:</i></b>The relationship between exposure to asbestos and malignant pleural mesothelioma (MPM) is already well established. Nevertheless, much remains to be known about exposure thereto and the incidence and mortality from MPM. <b><i>Objective:</i></b> This systematic review aims to map the relationship between asbestos and MPM by studying the exposure to asbestos and the incidence and mortality of MPM. <b><i>Methods:</i></b> A systematic review was conducted relating asbestos and MPM. Exposure to asbestos, incidence, and mortality by MPM was reviewed. PubMed, Web of Science, Cochrane Library, RCAAP, DART-Europe, and the reference lists of included studies were searched, from January 1, 1960, to December 31, 2020. Methodological quality was checked, the risk of bias analysis was performed, a level of evidence grade was assigned, and descriptive data analysis was performed. <b><i>Results:</i></b> 3,484 unique citations were identified, which included seventeen observational studies that met inclusion criteria with a total of 1,104 patients. Heterogeneity is present between the included studies which range from a case series of 16 retrospective studies and 1 prospective study. Studies were mostly conducted in Europe, particularly in Italy (6), and were published between 1969 and 2020. The mean age of patients is approximately 66 years with a latency period between the first exposure and diagnosis of approximately 42 years. 14 studies present data regarding the occupational context and chrysotile and crocidolite are the most studied types of fibre. The incidence of cases occurred between the interval 1966 and 2014 and in 9 studies the mortality rate was 100% of patients. <b><i>Conclusion:</i></b> There is high evidence to support the relationships between asbestos and MPM. However, the relatively scant information provided by the studies reinforces the need for well-conducted research and implementation of National Mesothelioma Surveillance Centres at a global level.
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Correia AI, Galaio L, Almeida C, Sacadura-Leite E. Respiratory And Non-Respiratory Symptoms In Health Care Professionals Infected With Sars-Cov-2 – Reported Cases In The First Wave Of Covid-19 In A Portuguese Occupational Health Service. Saf Health Work 2022. [PMCID: PMC8817361 DOI: 10.1016/j.shaw.2021.12.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Santos C, Dixe MDA, Sacadura-Leite E, Astoul P, Sousa-Uva A. Asbestos Exposure and Malignant Pleural Mesothelioma: A Systematic Review of Literature. Port J Public Health 2022. [DOI: https:/doi.org/10.1159/000527971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
<b><i>Background:</i></b>The relationship between exposure to asbestos and malignant pleural mesothelioma (MPM) is already well established. Nevertheless, much remains to be known about exposure thereto and the incidence and mortality from MPM. <b><i>Objective:</i></b> This systematic review aims to map the relationship between asbestos and MPM by studying the exposure to asbestos and the incidence and mortality of MPM. <b><i>Methods:</i></b> A systematic review was conducted relating asbestos and MPM. Exposure to asbestos, incidence, and mortality by MPM was reviewed. PubMed, Web of Science, Cochrane Library, RCAAP, DART-Europe, and the reference lists of included studies were searched, from January 1, 1960, to December 31, 2020. Methodological quality was checked, the risk of bias analysis was performed, a level of evidence grade was assigned, and descriptive data analysis was performed. <b><i>Results:</i></b> 3,484 unique citations were identified, which included seventeen observational studies that met inclusion criteria with a total of 1,104 patients. Heterogeneity is present between the included studies which range from a case series of 16 retrospective studies and 1 prospective study. Studies were mostly conducted in Europe, particularly in Italy (6), and were published between 1969 and 2020. The mean age of patients is approximately 66 years with a latency period between the first exposure and diagnosis of approximately 42 years. 14 studies present data regarding the occupational context and chrysotile and crocidolite are the most studied types of fibre. The incidence of cases occurred between the interval 1966 and 2014 and in 9 studies the mortality rate was 100% of patients. <b><i>Conclusion:</i></b> There is high evidence to support the relationships between asbestos and MPM. However, the relatively scant information provided by the studies reinforces the need for well-conducted research and implementation of National Mesothelioma Surveillance Centres at a global level.
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Mendonça-Galaio L, Sacadura-Leite E, Raposo J, França D, Correia A, Lobo R, Soares J, Almeida C, Shapovalova O, Serranheira F, Sousa-Uva A. The COVID-19 Impact in Hospital Healthcare Workers: Development of an Occupational Health Risk Management Program. Port J Public Health 2021. [PMCID: PMC8247828 DOI: 10.1159/000515327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
As with the SARS-CoV-1 outbreak in 2003–2004 and the MERS outbreak in 2012, there were early reports of frequent transmission to healthcare workers (HCW) in the SARS-CoV-2 pandemic. Our hospital center identified its first COVID-19 confirmed case on March 9, 2020, in a 6-day hospitalized patient. The first confirmed COVID-19 case in a HCW happened 3 days later, in a nurse with a probable epidemiological link related to the first confirmed patient. Our study's first objective is to describe and characterize the impact of the first 3 months of the SARS-CoV-2 pandemic on the Centro Hospitalar Universitário Lisboa Norte (CHULN). Our second objective is to report the performance of the CHULN Occupational Health Department (OHD) and the impact of the pandemic on CHULN HCW and its adaptation across national, regional, and institutional epidemiological evolution. Over the first 3 months, 2,152 HCW were screened (which represent 29.8% of the total HCW population), grouped in 100 separate identifiable clusters, each one ranging from 2 to 98 HCW. The most prevalent profession screened were nurses (n = 800; 37.2%) followed by doctors (n = 634; 29.5%). The main source of potential infection and cluster generating screening procedures was co-worker related (n = 1,216; 56.5%). A patient source or a combined patient co-worker source was only accountable for 559 (26%) and 43 (2%) of cases, respectively. Our preliminary results demonstrate a lower infection rate among HCW than the ones commonly found in the literature. The main source of infection seemed to be co-worker related rather than patient related. New preventive strategies would have to be implemented in order to control SARS-CoV-2 spread.
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Affiliation(s)
- Luís Mendonça-Galaio
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
- Occupational and Environmental Health Department of NOVA National School of Public Health, Lisbon, Portugal
- *Luís Mendonça-Galaio,
| | - Ema Sacadura-Leite
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
- Occupational and Environmental Health Department of NOVA National School of Public Health, Lisbon, Portugal
- Institute for Preventive Medicine and Public Health of University of Lisbon School of Medicine, Lisbon, Portugal
| | - João Raposo
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Diana França
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Correia
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Rodrigo Lobo
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Jorge Soares
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Clara Almeida
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Olena Shapovalova
- Department of Occupational Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Florentino Serranheira
- Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
- Occupational and Environmental Health Department of NOVA National School of Public Health, Lisbon, Portugal
| | - António Sousa-Uva
- Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
- Occupational and Environmental Health Department of NOVA National School of Public Health, Lisbon, Portugal
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12
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Navarro Morales G, Shapovalova O, Sacadura-Leite E. [Seroprevalence of Measles Antibodies in Healthcare Professionals in a Central Hospital in Portugal]. ACTA MEDICA PORT 2021; 34:111-117. [PMID: 33320081 DOI: 10.20344/amp.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 05/31/2020] [Accepted: 09/02/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Immunity against measles may result from previous contact with the virus or vaccination. In this study we aimed to evaluate the prevalence of immunity to measles in healthcare professionals of a central hospital. MATERIAL AND METHODS Retrospective study, with description of the results of measles-specific IgG assay in healthcare professionals, between May 2010 and March 2018. RESULTS The results of 1339 healthcare professionals were analyzed. The average age was 39.3 ± 10.11 years, 71.1% female. The prevalence of positive IgG was 81.5%, higher among professionals in the age groups 40 - 49 and over 50 years (91.9% and 94.6% respectively). Healthcare professionals who presented negative or equivocal IgG were mostly under 40 years old (83.1%) (p < 0.05). DISCUSSION The prevalence of serological immunity to measles in healthcare professionals was found to be lower than in other studies. That may be due to differences between the characteristics of the studied samples. Susceptibility to measles was higher in lower age groups. These results may reflect low vaccination coverage in this age group, an incomplete vaccination schedule, or the possibility of older healthcare professionals having the disease, which may confer an immune response with higher IgG levels. CONCLUSION Knowing the prevalence of susceptibility to measles in healthcare professionals enabled the establishment of prevention strategies for outbreaks that may occur. Vaccination remains the best preventative measure, but a third dose of vaccine may be considered in certain epidemiological contexts, particularly in the youngest exposed healthcare professionals.
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Affiliation(s)
- Gary Navarro Morales
- Serviço de Saúde Ocupacional. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Olena Shapovalova
- Serviço de Saúde Ocupacional. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Ema Sacadura-Leite
- Serviço de Saúde Ocupacional. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Escola Nacional de Saúde Pública (ENSP/NOVA). Centro de Investigação em Saúde Pública (CISP/NOVA). Universidade NOVA de Lisboa. Lisboa. Instituto de Medicina Preventiva. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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13
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Ramos S, Costa P, Passos AM, Silva SA, Sacadura-Leite E. Intervening on Burnout in Complex Organizations - The Incomplete Process of an Action Research in the Hospital. Front Psychol 2020; 11:2203. [PMID: 33071844 PMCID: PMC7538901 DOI: 10.3389/fpsyg.2020.02203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
Health professionals are at high risk for developing burnout symptoms. Directed at reducing the organizational variables affecting professionals’ burnout, an action research was developed in a specific sector of a large hospital, with 59 doctors, 66 nurses, and 42 ancilliary professionals. Researchers conducted 11 interviews, one focus group, and 20 h of in loco observation. Professionals report demotivation and the need to address the emotional part of their job. Nonetheless, the hierarchy blocked the proposed intervention possibilities. Organizational factors are unequivocally relevant, particularly in complex settings with emotionally charged interactions, and the direct hierarchy is pivotal for facilitating organizational change.
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Affiliation(s)
- Sara Ramos
- DINÂMIA'CET-IUL, ISCTE-IUL, Lisbon, Portugal
| | - Patrícia Costa
- Business Research Unit (BRU-IUL), ISCTE-IUL, Lisbon, Portugal
| | - Ana M Passos
- Business Research Unit (BRU-IUL), ISCTE-IUL, Lisbon, Portugal
| | - Sílvia A Silva
- Business Research Unit (BRU-IUL), ISCTE-IUL, Lisbon, Portugal
| | - Ema Sacadura-Leite
- Occupational Health Service, North Lisbon University Hospital Center, Lisbon, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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14
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Romão VC, Oliveira-Ramos F, Cruz-Machado AR, Martins P, Barreira S, Silva-Dinis J, Mendonça-Galaio L, Proença H, Cristino JM, Sacadura-Leite E, Khmelinskii N, Romeu JC, Fonseca JE. A COVID-19 Outbreak in a Rheumatology Department Upon the Early Days of the Pandemic. Front Med (Lausanne) 2020; 7:576162. [PMID: 33102507 PMCID: PMC7546334 DOI: 10.3389/fmed.2020.576162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/14/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives: To describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a large rheumatology department early in the pandemic. Methods: Symptomatic and asymptomatic healthcare workers (HCWs) had a naso-oropharyngeal swab for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were followed clinically. Reverse transcription polymerase-chain reaction (RT-PCR) was repeated to document cure, and serological response was assessed. Patients with risk contacts within the department in the 14 days preceding the outbreak were screened for COVID-19 symptoms. Results: 14/34 HCWs (41%; 40 ± 14 years, 71% female) tested positive for SARS-CoV-2, and 11/34 (32%) developed symptoms but were RT-PCR-negative. Half of RT-PCR-positive HCWs did not report fever, cough, or dyspnea before testing, which were absent in 3/14 cases (21%). Mild disease prevailed (79%), but 3 HCWs had moderate disease requiring further assessment, which excluded severe complications. Nevertheless, symptom duration (28 ± 18 days), viral shedding (31 ± 10 days post-symptom onset, range 15-51), and work absence (29 ± 28 days) were prolonged. 13/14 (93%) of RT-PCR-positive and none of the RT-PCR-negative HCWs had a positive humoral response Higher IgG indexes were observed in individuals over 50 years of age (14.5 ± 7.7 vs. 5.0 ± 4.4, p = 0.012). Of 617 rheumatic patients, 8 (1.3%) developed COVID-19 symptoms (1/8 hospitalization, 8/8 complete recovery), following a consultation/procedure with an asymptomatic (7/8) or mildly symptomatic (1/8) HCW. Conclusions: A COVID-19 outbreak can occur among HCWs and rheumatic patients, swiftly spreading over the presymptomatic stage. Mild disease without typical symptoms should be recognized and may evolve with delayed viral shedding, prolonged recovery, and adequate immune response in most individuals.
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Affiliation(s)
- Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filipa Oliveira-Ramos
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Rita Cruz-Machado
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia Martins
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Barreira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Silva-Dinis
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Luís Mendonça-Galaio
- Occupational Health Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Helena Proença
- Clinical Pathology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
| | - José Melo Cristino
- Clinical Pathology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ema Sacadura-Leite
- Occupational Health Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - José Carlos Romeu
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Santos C, Dixe MA, Sacadura-Leite E, Astoul P, Sousa-Uva A. Asbestos Exposure and Malignant Pleural Mesothelioma in Portugal: a scoping review. Eur J Public Health 2020. [DOI: https://doi.org/10.1093/eurpub/ckaa040.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Introduction Asbestos, widely used for its important chemical and physical characteristics, are recognized in all their varieties as a human carcinogen by the International Agency for Research on Cancer (IARC) and as the leading cause of cancer associated with occupational exposure in industrialized countries. Despite being the most studied occupational hazard since 1965, it is the malignant pleural mesothelioma (MPM), the decisive aspect in the study of the exposure to asbestos.
Objectives Make a state of the art of the relationships between asbestos and MPM in Portugal.
Methodology A scoping review using the Joanna Briggs Institute (JBI) methodology was conducted using five information’s sources: Pubmed, Web of Science, The Cochrane Library, Scopus and Google Scholar and Open Access Scientific Repositories of Portugal and DART-Europe E-theses Portal to search also for gray literature. Data were collected between 1960-2019, with the keywords "Asbestos" and "Mesothelioma” and “Portugal”. Inclusion criteria were defined for types of participants, concept, context and types of studies.
Results Of the 1453 studies reviewed 9 were included. The oldest study is from 1986. Five studies are about incidence and survival, two are case reports, one about exposure and mortality and one about treatment. To analyse incidence and mortality, four authors used hospital data and two the data from the southern regional cancer registry (ROR). In these studies, it is also presented the description of the population in terms of mean age, type of exposure, latency time, histological type and stage.
Conclusion Portugal, such as other industrialized countries, used asbestos in a massive way, but despite this, few studies and data on the relationship between asbestos exposure and MPM are found. Dedicated studies are needed to objectively assess the true dimension of this potential problem in Portugal and characterise the different types of exposures related to MPM.
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Affiliation(s)
- C Santos
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; Centro Hospitalar de Leiria, Portugal
| | - MA Dixe
- Instituto Politécnico de Leiria; ciTechCare, Portugal
| | - E Sacadura-Leite
- Departamento de Saúde Ocupacional e Ambiental da Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; CISP - Centro de Investigação em Saúde Pública; Serviço de Saúde Ocupacional do CHLN, Portugal
| | - P Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology; Hôpital Nord – Aix-Marseille University, France
| | - A Sousa-Uva
- Coordenador do Departamento de Saúde Ocupacional e Ambiental da Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; CISP - Centro de Investigação em Saúde Pública, Portugal
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16
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Santos C, Dixe MA, Sacadura-Leite E, Astoul P, Sousa-Uva A. Asbestos Exposure and Malignant Pleural Mesothelioma in Portugal: a scoping review. Eur J Public Health 2020. [DOI: https:/doi.org/10.1093/eurpub/ckaa040.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Abstract
Introduction Asbestos, widely used for its important chemical and physical characteristics, are recognized in all their varieties as a human carcinogen by the International Agency for Research on Cancer (IARC) and as the leading cause of cancer associated with occupational exposure in industrialized countries. Despite being the most studied occupational hazard since 1965, it is the malignant pleural mesothelioma (MPM), the decisive aspect in the study of the exposure to asbestos.
Objectives Make a state of the art of the relationships between asbestos and MPM in Portugal.
Methodology A scoping review using the Joanna Briggs Institute (JBI) methodology was conducted using five information’s sources: Pubmed, Web of Science, The Cochrane Library, Scopus and Google Scholar and Open Access Scientific Repositories of Portugal and DART-Europe E-theses Portal to search also for gray literature. Data were collected between 1960-2019, with the keywords "Asbestos" and "Mesothelioma” and “Portugal”. Inclusion criteria were defined for types of participants, concept, context and types of studies.
Results Of the 1453 studies reviewed 9 were included. The oldest study is from 1986. Five studies are about incidence and survival, two are case reports, one about exposure and mortality and one about treatment. To analyse incidence and mortality, four authors used hospital data and two the data from the southern regional cancer registry (ROR). In these studies, it is also presented the description of the population in terms of mean age, type of exposure, latency time, histological type and stage.
Conclusion Portugal, such as other industrialized countries, used asbestos in a massive way, but despite this, few studies and data on the relationship between asbestos exposure and MPM are found. Dedicated studies are needed to objectively assess the true dimension of this potential problem in Portugal and characterise the different types of exposures related to MPM.
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Affiliation(s)
- C Santos
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; Centro Hospitalar de Leiria, Portugal
| | - MA Dixe
- Instituto Politécnico de Leiria; ciTechCare, Portugal
| | - E Sacadura-Leite
- Departamento de Saúde Ocupacional e Ambiental da Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; CISP - Centro de Investigação em Saúde Pública; Serviço de Saúde Ocupacional do CHLN, Portugal
| | - P Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology; Hôpital Nord – Aix-Marseille University, France
| | - A Sousa-Uva
- Coordenador do Departamento de Saúde Ocupacional e Ambiental da Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; CISP - Centro de Investigação em Saúde Pública, Portugal
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Santos C, Dixe MA, Sacadura-Leite E, Astoul P, Sousa-Uva A. Asbestos Exposure and Malignant Pleural Mesothelioma in Portugal: a scoping review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction Asbestos, widely used for its important chemical and physical characteristics, are recognized in all their varieties as a human carcinogen by the International Agency for Research on Cancer (IARC) and as the leading cause of cancer associated with occupational exposure in industrialized countries. Despite being the most studied occupational hazard since 1965, it is the malignant pleural mesothelioma (MPM), the decisive aspect in the study of the exposure to asbestos.
Objectives Make a state of the art of the relationships between asbestos and MPM in Portugal.
Methodology A scoping review using the Joanna Briggs Institute (JBI) methodology was conducted using five information’s sources: Pubmed, Web of Science, The Cochrane Library, Scopus and Google Scholar and Open Access Scientific Repositories of Portugal and DART-Europe E-theses Portal to search also for gray literature. Data were collected between 1960-2019, with the keywords "Asbestos" and "Mesothelioma” and “Portugal”. Inclusion criteria were defined for types of participants, concept, context and types of studies.
Results Of the 1453 studies reviewed 9 were included. The oldest study is from 1986. Five studies are about incidence and survival, two are case reports, one about exposure and mortality and one about treatment. To analyse incidence and mortality, four authors used hospital data and two the data from the southern regional cancer registry (ROR). In these studies, it is also presented the description of the population in terms of mean age, type of exposure, latency time, histological type and stage.
Conclusion Portugal, such as other industrialized countries, used asbestos in a massive way, but despite this, few studies and data on the relationship between asbestos exposure and MPM are found. Dedicated studies are needed to objectively assess the true dimension of this potential problem in Portugal and characterise the different types of exposures related to MPM.
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Affiliation(s)
- C Santos
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; Centro Hospitalar de Leiria, Portugal
| | - MA Dixe
- Instituto Politécnico de Leiria; ciTechCare, Portugal
| | - E Sacadura-Leite
- Departamento de Saúde Ocupacional e Ambiental da Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; CISP - Centro de Investigação em Saúde Pública; Serviço de Saúde Ocupacional do CHLN, Portugal
| | - P Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology; Hôpital Nord – Aix-Marseille University, France
| | - A Sousa-Uva
- Coordenador do Departamento de Saúde Ocupacional e Ambiental da Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; CISP - Centro de Investigação em Saúde Pública, Portugal
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França D, Sacadura-Leite E, Fernandes-Almeida C, Filipe P. Occupational dermatoses among healthcare workers in a hospital center in Portugal. Rev Bras Med Trab 2020; 17:285-291. [PMID: 32368662 PMCID: PMC7195876 DOI: 10.5327/z1679443520190393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/08/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually. OBJECTIVE To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors. METHODS Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year. RESULTS About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%). CONCLUSION The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.
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Affiliation(s)
- Diana França
- Occupational Health Department, North Lisbon Hospital Center – Lisbon, Portugal
| | - Ema Sacadura-Leite
- Occupational Health Department, North Lisbon Hospital Center – Lisbon, Portugal
| | | | - Paulo Filipe
- Dermatology Department, North Lisbon Hospital Center – Lisbon, Portugal
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Sacadura-Leite E, Sousa-Uva A, Ferreira S, Costa PL, Passos AM. Working conditions and high emotional exhaustion among hospital nurses. Rev Bras Med Trab 2020; 17:69-75. [PMID: 32270106 DOI: 10.5327/z1679443520190339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/17/2019] [Indexed: 02/05/2023] Open
Abstract
Background Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses. Objective The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case. Methods We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old). Results We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025). Conclusion Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs.
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Affiliation(s)
- Ema Sacadura-Leite
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa - Lisboa, Portugal.,Departamento de Saúde Ocupacional e Ambiental - Lisboa, Portugal.,Centro Hospitalar Universitário Lisboa Norte, Serviço de Saúde Ocupacional - Lisboa, Portugal.,Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal
| | - Antonio Sousa-Uva
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa - Lisboa, Portugal.,Departamento de Saúde Ocupacional e Ambiental - Lisboa, Portugal
| | - Sancha Ferreira
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Saúde Ocupacional - Lisboa, Portugal
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Antão HS, Sacadura-Leite E, Manzano MJ, Pinote S, Relvas R, Serranheira F, Sousa-Uva A. Workplace Violence in Healthcare: A Single-Center Study on Causes, Consequences and Prevention Strategies. ACTA MEDICA PORT 2020; 33:31-37. [PMID: 31928601 DOI: 10.20344/amp.11465] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/10/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Workplace violence is one of the main risk factors in the professional world. Healthcare workers are at higher risk when compared to other sectors. Our study aimed to characterize physical and verbal violence in a public hospital and to define occupational health prevention and surveillance strategies. MATERIAL AND METHODS Single center observational cross-sectional study, carried amongst healthcare workers in a public hospital in Lisbon. A qualitative survey was carried out through six in-depth interviews. A quantitative survey was carried through questionnaires delivered to 32 workers. A significance level of 5% was accepted in the assessment of statistical differences. The Mann-Whitney test and the Fisher's exact test were used to calculate p values. RESULTS The main results are: (1) 41 violence incidents were reported in the quantitative phase; (2) 5/21 [23.81%] victims notified the incident to the occupational health department; (3) 18/21 [85.71%] victims reported a permanent state of hypervigilance; (4) 22/28 [78.57%] participants self-reported poor or no familiarity with internal reporting procedures; (5) 24/28 [85.71%] participants believed it is possible to minimize workplace violence. DISCUSSION Workplace violence is favored by unrestricted access to working areas, absence of security guards and police officers or scarce intervention. The low notification rate contributes to organizational lack of action. The state of hypervigilance reported in our study reflects the negative effects of threatening occupational stressors on mental health. CONCLUSION Our results show that workplace violence is a relevant risk factor that significantly impacts workers' health in a noxious manner, deserving a tailored occupational health approach whose priority areas and strategies have been determined.
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Affiliation(s)
- Helena Sofia Antão
- Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Emergency Department. Hospital Professor Doutor Fernando da Fonseca. Amadora. Portugal
| | - Ema Sacadura-Leite
- CISP - Centro de Investigação em Saúde Pública. CHRC - Comprehensive Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Maria João Manzano
- Occupational Health Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Sónia Pinote
- Occupational Health Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Rui Relvas
- Occupational Health Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Florentino Serranheira
- CISP - Centro de Investigação em Saúde Pública. CHRC - Comprehensive Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - António Sousa-Uva
- CISP - Centro de Investigação em Saúde Pública. CHRC - Comprehensive Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
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Sacadura-Leite E, Mendonça-Galaio L, Shapovalova O, Pereira I, Rocha R, Sousa-Uva A. Biological Hazards for Healthcare Workers: Occupational Exposure to Vancomycin-Resistant Staphylococcus aureus as an Example of a New Challenge. Port J Public Health 2018. [DOI: 10.1159/000487746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Tavares JB, Sacadura-Leite E, Matoso T, Neto LL, Biscoito L, Campos J, Sousa-Uva A. The importance of protection glasses during neuroangiographies: A study on radiation exposure at the lens of the primary operator. Interv Neuroradiol 2016; 22:368-71. [PMID: 26842605 PMCID: PMC4984365 DOI: 10.1177/1591019916628322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/26/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In interventional neuroradiology, few operators routinely use radiation protection glasses. Moreover, in most centers, radiation dose data only accounts for whole body dose without specific information on lens dose. In 2012, the International Commission on Radiological Protection advised that the threshold limit value for the lens should be 20 mSv/year instead of the previous 150 mSv/year limit. The purpose of this study was to compare the radiation dose in the operator's lens during real diagnostic and interventional neuroangiographies, either using or without lead protection glasses. METHODS Using the Educational Direct Dosimeter (EDD30 dosimeter), accumulated radiation dose in the lens was measured in 13 neuroangiographies: seven diagnostic and six interventional. Operators with and without radiation protection glasses were included and the sensor was placed near their left eye, closest to the radiation beam. RESULTS Without glasses, the corrected mean dose of radiation in the lens was 8.02 µSv for diagnostic procedures and 168.57 µSv for interventional procedures. Using glasses, these values were reduced to 1.74 µSv and 33.24 µSv, respectively. CONCLUSION Considering 20 mSv as the suggested annual limit of equivalent dose in the lens, neuroradiologists may perform up to 2,494 diagnostic procedures per year without protecting glasses, a number that increases to 11,494 when glasses are used consistently. Regarding intervention, a maximum of 119 procedures per year is advised if glasses are not used, whereas up to 602 procedures/year may be performed using this protection. Therefore, neuroradiologists should always wear radiation protection glasses.
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Affiliation(s)
- J B Tavares
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal Department of Occupational Health, North Lisbon Medical Center, Lisbon, Portugal
| | - E Sacadura-Leite
- Department of Occupational Health, North Lisbon Medical Center, Lisbon, Portugal CISP, National School of Public Health/NOVA, Lisbon, Portugal
| | - T Matoso
- Department of Occupational Health, North Lisbon Medical Center, Lisbon, Portugal
| | - L L Neto
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal
| | - L Biscoito
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal
| | - J Campos
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal
| | - A Sousa-Uva
- CISP, National School of Public Health/NOVA, Lisbon, Portugal
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Alves de Moura P, Serranheira F, Sacadura-Leite E. Psychosocial risks in Psychiatry and Anaesthesiology residents in a Portuguese General and University Hospital. Med Lav 2016; 107:129-140. [PMID: 27015028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/15/2015] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Medical Doctors (MD), although at the front line of response to patients and their families, are seldom study subjects for occupational psychosocial risks and work related stress. OBJECTIVES Assess psychiatry and anaesthesiology residents in a central and university Portuguese Hospital for the presence of psychosocial risks at work. METHODS We used the Copenhagen Psychosocial Questionnaire version 2 (COPSOQ), which was applied face-to-face in two group settings, in April 2014. It comprised a sample of 19 Psychiatry residents and 20 Anaesthesiology residents. Statistical analysis was done by correlational analysis using Pearson's coefficient (r) and the t-student test for categorical variables. RESULTS An occupational health risk (red flag) was found for residents in the "Cognitive demands" dimension of COPSOQ and a health risk (red flag) in the "Work influence" dimension for the female Anaesthesiology sub-group. A possible risk (yellow flag) was found in 17 dimensions. Results also showed moderate correlations between various COPSOQ dimensions and the emergency department workload, workload, home study, number of children, year of training and the medical specialty variables. CONCLUSIONS These results suggest that residents have a health risk which derives from the cognitive demands of their work and that it increases with the workload. This implicates the need for occupational health measures to be taken to manage and reduce these psychological risks.
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Tavares JB, Sacadura-Leite E, Matoso T, Neto LL, Biscoito L, Campos J, Sousa-Uva A. The importance of protection glasses during neuroangiographies: A study on radiation exposure at the lens of the primary operator. Interv Neuroradiol 2016. [DOI: %20doi:%2010.1177/1591019916628322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background In interventional neuroradiology, few operators routinely use radiation protection glasses. Moreover, in most centers, radiation dose data only accounts for whole body dose without specific information on lens dose. In 2012, the International Commission on Radiological Protection advised that the threshold limit value for the lens should be 20 mSv/year instead of the previous 150 mSv/year limit. The purpose of this study was to compare the radiation dose in the operator’s lens during real diagnostic and interventional neuroangiographies, either using or without lead protection glasses. Methods Using the Educational Direct Dosimeter (EDD30 dosimeter), accumulated radiation dose in the lens was measured in 13 neuroangiographies: seven diagnostic and six interventional. Operators with and without radiation protection glasses were included and the sensor was placed near their left eye, closest to the radiation beam. Results Without glasses, the corrected mean dose of radiation in the lens was 8.02 µSv for diagnostic procedures and 168.57 µSv for interventional procedures. Using glasses, these values were reduced to 1.74 µSv and 33.24 µSv, respectively. Conclusion Considering 20 mSv as the suggested annual limit of equivalent dose in the lens, neuroradiologists may perform up to 2,494 diagnostic procedures per year without protecting glasses, a number that increases to 11,494 when glasses are used consistently. Regarding intervention, a maximum of 119 procedures per year is advised if glasses are not used, whereas up to 602 procedures/year may be performed using this protection. Therefore, neuroradiologists should always wear radiation protection glasses.
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Affiliation(s)
- JB Tavares
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal
- Department of Occupational Health, North Lisbon Medical Center, Lisbon, Portugal
| | - E Sacadura-Leite
- Department of Occupational Health, North Lisbon Medical Center, Lisbon, Portugal
- CISP, National School of Public Health/NOVA, Lisbon, Portugal
| | - T Matoso
- Department of Occupational Health, North Lisbon Medical Center, Lisbon, Portugal
| | - LL Neto
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal
| | - L Biscoito
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal
| | - J Campos
- Department of Neuroimaging, North Lisbon Medical Center, Lisbon, Portugal
| | - A Sousa-Uva
- CISP, National School of Public Health/NOVA, Lisbon, Portugal
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Costa PL, Passos AM, Silva SA, Sacadura-Leite E, Tavares SM, Spanu F, Dimitrova E, Basarovska V, Milosevic M, Turk M, Panagopoulou E, Montgomery A. Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity. Revista de Psicología del Trabajo y de las Organizaciones 2014. [DOI: 10.1016/j.rpto.2014.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sacadura-Leite E, Sousa-Uva A, Rebelo-de-Andrade H, Ferreira S, Rocha R. Association between chronic stress and immune response to influenza vaccine in healthcare workers. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rpsp.2013.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Sacadura-Leite E, Sousa-Uva A, Rebelo-de-Andrade H. Antibody response to the influenza vaccine in healthcare workers. Vaccine 2011; 30:436-41. [PMID: 22064268 DOI: 10.1016/j.vaccine.2011.10.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/13/2011] [Accepted: 10/24/2011] [Indexed: 02/05/2023]
Abstract
People vaccinated against influenza develop hemagglutination inhibition (HAI) antibodies (Ab) that bind to the virus and neutralize it. Ab titer levels are variable depending on factors insufficiently studied, and tend to decrease over time. In the present study, we analyzed antibodies responses before and after influenza vaccination in nurses working in a hospital, with the aim of: - identifying seroconversion rates to trivalent influenza vaccine one month after immunization; - evaluating if, six months after vaccination, influenza HAI Ab titer fall comparing to one-month post vaccination HAI Ab titer; - studying the association between the lack of HAI Ab response (seroconversion) assessed one month after immunization and: ◦ past influenza vaccinations, ◦ baseline (before vaccination) HAI Ab titer, ◦ baseline (before vaccination) HAI Ab titer ≥ 40 (considered as a protection titer). Hemagglutination inhibition reaction was used to assess specific HAI Ab titers against influenza A(H(1)N(1)), A(H(3)N(2)) and B virus strains included in the influenza vaccine and we used progressive dilutions of two times, starting on 1:10 until 1:20.480. Seroconversion rates, one month after vaccination, were 66.7% for A(H(1)N(1)) strain, 63.2% for A(H(3)N(2)) strain and 56.3% for B strain. The most immunogenic strain used in 2007/08 influenza vaccine was A(H(1)N(1)). Seroconversion rates after one month were negatively associated with past influenza vaccinations, baseline HAI Ab titers ≥ 40 and baseline HAI Ab titers. Six months after vaccination, 50% of participants showed a drop in HAI Ab titers to an half, for each of the considered strains, but they remain high enough to protect against the disease.
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Affiliation(s)
- Ema Sacadura-Leite
- Occupational Health Department, Hospital de Santa Maria/CHLN, Av. Prof Egas Moniz, 1649-035 Lisbon, Portugal.
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