Spiritual Care through the Lens of Portuguese Palliative Care Professionals: A Qualitative Thematic Analysis

Providing spiritual care is paramount to patient-centered care. Despite the growing body of data and its recognized importance in palliative care, spiritual care continues to be the least advanced and most overlooked aspect. This study aims to explore the perceptions and experiences of spiritual care from the perspective of PC professionals and identify their strategies to address spiritual care issues. Data were collected through semi-structured personal interviews and managed using WebQDA software (Universidade de Aveiro, Aveiro, Portugal). All data were analyzed using thematic content analysis, as recommended by Clark and Braun. The study included 15 palliative care professionals with a mean age of 38.51 [SD = 5.71] years. Most participants identified as lacking specific training in spiritual care. Thematic analysis spawned three main themes: (1) spiritual care as key to palliative care, (2) floating between "shadows" and "light" in providing spiritual care, and (3) strategies for competent and spiritual-centered care. Spiritual care was considered challenging by its very nature and given the individual, relational, and organizational constraints lived by professionals working in palliative care. With support from healthcare institutions, spiritual care can and should become a defining feature of the type, nature, and quality of palliative care provision. Care providers should be sensitive to spiritual needs and highly skilled and capable of an in-the-moment approach to respond to these needs. Further research on educating and training in spiritual care competence is a priority.

Antimicrobial activity of root canal filling pastes used in pediatric dentistry

This study evaluated the antimicrobial activity of root canal filling pastes commonly used in primary teeth: iodoform paste, zinc oxide-eugenol (ZOE), and analytical grade calcium hydroxide (Ca[OH]₂). The materials were evaluated in the following 6 combinations: iodoform paste (Rifocort [prednisolone + rifampicin] + iodoform + camphorated paramonochlorophenol); zinc oxide + eugenol in a proportion of 1:3; zinc oxide + eugenol in a proportion of 1:5; Ca(OH)₂ + water; iodoform paste + ZOE (1:3) + Ca(OH)₂; and ZOE (1:3) + Ca(OH)₂. Chlorhexidine gel (0.2%) served as the positive control. A commercial strain of Enterococcus faecalis (ATCC 25175) was plated in petri dishes containing 10 mL of brain-heart infusion agar culture medium with a hole in the center. The filling pastes (3 g) were manipulated and inserted in the hole. The plates were incubated at 37°C for 48 hours, and then the inhibition zone associated with each paste was measured. The experiments were carried out in triplicate (n = 3 per group). The data were submitted to analysis of variance and Tukey tests (P < 0.05). Iodoform paste resulted in the largest mean (SD) inhibition zone, 7.06 (0.74) mm. The smallest was obtained with Ca(OH)₂ + water, the mean (SD) of 0.00 (0.00) mm indicating that these specimens did not form an inhibition zone. The ZOE pastes in proportions of 1:3 and 1:5 resulted in statistically similar mean (SD) inhibition zones of 1.86 (0.50) and 1.30 (0.18) mm, respectively (P > 0.05). Of the test materials, the combination of iodoform paste + ZOE + Ca(OH)₂ presented the second largest inhibition zone, 6.27 (3.08) mm, significantly different from that of the non-iodoform pastes (P < 0.05). It can be concluded that iodoform paste, alone or in combination with ZOE + Ca(OH)₂, demonstrates high antimicrobial activity, while the combination of ZOE + Ca(OH)₂ demonstrates moderate activity.

“CicloExpresso das Barrocas”: a Portuguese example of promoting physical activity

Issue

Active travel to school is one of the main forms of physical activity for children, contributing to attainment of several of the United Nations Sustainable Development Goals. Young people who travel to school in an active way increase the overall amount of time they spend being physically active each day.

Description of the Problem

In 2017 the association Ciclaveiro created the 'CicloExpresso das Barrocas” in Aveiro. The 'CicloExpresso das Barrocas” is a “bike train” comprising a group of children cycling to their school - Escola Básica das Barrocas - accompanied by parents. It is organized by a group of parents, with the support of the local parish council and school parents associations. The main objective was to promote sustainable mobility and get children to go to school in sustainable and healthy means of transport.

Results

Since 2017 more “train lines” were created to different schools, involving more children and parents. In the near future, the aim is to increase the numbers of “train lines”, schools involved,”trains” per week and children and parents who use them regularly. Physical activity has not only health benefits and contributes to a child's physical, mental and emotional development but also has potentially broad social and academic gains. Additionally it contributes to social cohesion, which in turn can boost confidence and self-esteem.

Lessons

The promotion of active travel to school can be challenging and may require support from sectors other than education. This example shows it can be implemented successfully through collaboration among relevant sectors. CicloExpresso have been getting public recognition. In Aveiro it received a “family-community involvement award for his work with CicloExpresso”.This example of good practice can provide inspiration for policy-makers, schools and researchers. They provide an overview of actions taken to increase physical activity among children and adolescents.

Key messages

Children who travel to school in an active way increase the time they spend being physically active each day. Active travel to school can be challenging and may require support from many sectors.

Medical certificate of disability: a descriptive analysis of Aveiro region, from 2010 to 2016

Background

In Portugal, Public Health Physicians attribute the medical certificate of disability (MCD). This document is mainly used for fiscal benefits or from other kind, as priority parking card and non-medical public services are increasing its requirement. The threshold to determine benefits is 60% of incapacity by law. Oncological, musculoskeletal and psychiatric diseases account for most of the cases. This activity is highly time-consuming and is not part of the Essential Public Health Operations or the competences of Public Health Physicians according to the Medical Professional Order. The aim of this study is to characterize the evolution of this procedure and the obtained incapacity values from 2010 to 2016 in the Public Health Unit of Baixo Vouga Primary Healthcare Cluster.

Methods

A descriptive analysis was made with the registers of production of MCD in four municipalities of the Aveiro Region from 2010 to 2016.

Results

An increase in the number of MCD was verified, going from 274 in 2010 to 550 in 2016, in a total of 3087. Two thousand and fifteen was the year with the greatest frequencies, with 632 certificates. The median value of incapacity was 60% (64% of total MCDs), with an interquartile amplitude of 12, varying from 6% to 99%. Incapacity values have an increasing tendency over the years, showing a cohort effect.

Conclusions

The increase of MCD reflects an enormous burden for the Public Health Services that consequently have fewer resources to deal with Essential Public Health Operations. Human resources or task distribution should be rethought in order to respond to population's needs. Cohort effects might be explained by the law-fixed re-evaluation, required every 5 years for oncological cases. In fact, this incapacity is the main cause of requirement of the MCD. Further studies should address this problematic in order to better organize the health services and understand the effectiveness of this procedure.

Key messages

The number of issued MCD is growing, overloading Health Services. The median incapacity is 60%, which is the threshold to attribute benefits. Further investigation is needed to address this issue.

Work absence and multimorbidity in Portugal: results from the 1st National Health Examination Survey

Background

Studies on the impact of patients with multimorbidity in the absence of work indicate that the number and type of chronic diseases may increase absenteeism and that the risk of absence from work is higher in people with two or more chronic diseases. This study analyzed the association between multimorbidity and greater frequency and duration of work absence in the portuguese population between the ages of 25 and 65 during 2015.

Methods

This is an epidemiological, observational, cross-sectional study with an analytical component that has its source of information from the 1st National Health Examination Survey. The study analyzed univariate, bivariate and multivariate variables under study. A multivariate logistic regression model was constructed.

Results

The prevalence of absenteeism was 55,1%. Education showed an association with absence of work (p = 0,0157), as well as professional activity (p = 0,0086). It wasn't possible to verify association between the presence of chronic diseases (p = 0,9358) or the presence of multimorbidity (p = 0,4309) with absence of work. The prevalence of multimorbidity was 31,8%. There was association between age (p &lt; 0,0001), education (p &lt; 0,001) and yield (p = 0,0009) and multimorbidity. There is no increase in the number of days of absence from work due to the increase in the number of chronic diseases. In the optimized logistic regression model the only variables that demonstrated association with the variable labor absence were age (p = 0,0391) and education (0,0089).

Conclusions

The scientific evidence generated will contribute to the current discussion on the need for the health and social security system to develop policies to patients with multimorbidity.

Key messages

The prevalence of absenteeism and multimorbidity in Portugal was respectively 55,1% and 31,8%. In the optimized model age and education demonstrated association with the variable labor absence.

Determination of Naringin and Neohesperidin in Orange Juice by Liquid Chromatography with UV Detection to Detect the Presence of Grapefruit Juice: Collaborative Study

Fifteen collaborating laboratories were sent 9 samples of citrus juice mixtures as blind duplicates for determination of naringin and neohesperidin by liquid chromatography. Two sample pairs were 100% orange juice and did not contain any naringin or neohesperidin. The remaining 7 sample pairs contained naringin at levels ranging from 3.9 to 46.5 ppm and neohesperidin at levels ranging from 0.14 to 35.6 ppm. Five sample pairs consisted of orange juice mixtures containing 1, 3, and 5% grapefruit juice; 5% sour orange; and 5% K-Early citrus variety. Two sample pairs were orange juice spiked with naringin, neohesperidin, sodium benzoate, and potassium sorbate. Data were received from 13 laboratories. Data from 1 collaborator were eliminated because the method protocol was not followed. Neohesperidin values from another laboratory were also not used because of problems with a coeluting component. Repeatability relative standard deviations ranged from 2.95 to 15.23% for naringin and from 3.00 to 11.74% for neohesperidin. Reproducibility relative standard deviations ranged from 11.34 to 31.94% for naringin and from 10.45 to 26.17% for neohesperidin. The method is reliable for detecting the presence of grapefruit juice in orange juice as indicated by a finding of ≥10 ppm naringin and ≤2 ppm neohesperidin. The method was adopted First Action by AOAC INTERNATIONAL.

Bioprospection of Isochrysis galbana and its potential as a nutraceutical

Microalgae have strong potential as novel sources of nutraceuticals, as they contain significant amounts of highly valuable bioactive compounds. This study focuses on the bioprospection of biomass of the microalga Isochrysis galbana and its extracts (aqueous and ethanolic), determining total polyphenols, laminarin, fucoxanthin, coenzyme Q10, and β-carotene contents, and also assessing several biological activities (antioxidant, cytotoxicity, and hypocholesterolemic). I. galbana exhibited high phenolic content, both in aqueous and ethanolic extracts. The microalgal freeze-dried biomass presented a low laminarin content and higher content of fucoxanthin (6.10 mg per g dw), and relevant β-carotene and Coenzyme Q10 contents were detected. I. galbana aqueous extracts presented a high antioxidant capacity (approximately 90% inhibition by the ABTS method). Furthermore, I. galbana biomass and ethanolic extract showed significant cytotoxicity against HeLa human cervical cancer cells, with IC₅₀ values of 0.32 and 0.28 mg ml^-1 respectively, demonstrating potential for further anticancer studies. The aqueous extract of I. galbana induced a significant decrease of cholesterol absorption through Caco-2 monolayers, modelling the human intestinal barrier, which suggests that it may contribute to decreasing the dietary cholesterol absorption.

Microalgae as healthy ingredients for functional food: a review

Microalgae are very interesting and valuable natural sources of highly valuable bioactive compounds, such as vitamins, essential amino acids, polyunsaturated fatty acids, minerals, carotenoids, enzymes and fibre.

Potential for CSO treatment with horizontal flow constructed wetlands: influence of hydraulic load, plant presence and loading frequency

This study aimed at analysing the performance of horizontal subsurface flow constructed wetlands (CWs) to treat combined sewer overflow (CSO). Four horizontal subsurface flow CWs, organized in two groups (A and B) each with a planted (Phragmites australis) and a non-planted bed, were loaded with simulated CSO, with group B receiving twice the hydraulic load of group A. Beds were monitored for pH, dissolved oxygen, conductivity, redox potential, chemical oxygen demand (COD), total suspended solids (TSS) and enterococci. Porosity variations were also estimated. Monitoring was conducted during spring and wintertime, with regular and irregular loading frequencies. Results showed an average treatment efficiency of 90-100 % for TSS, 60-90 % for COD and 2-6 log for enterococci. Removal rates were especially relevant in the first 24 h for COD and TSS. TSS and enterococci removal did not exhibit the influence of macrophytes or the applied hydraulic load while COD's removal efficiency was lower in the higher load group and in planted beds.

Evaluation of Pax5 expression and comparison with BLA.36 and CD79αcy in feline non-Hodgkin lymphoma

Paired box gene 5 (Pax5) is a widely used B-cell marker for human and canine non-Hodgkin's lymphoma (nHL); however, in the literature there is only one case report using Pax5 in a cat B-cell lymphoma. The purposes of this study were to investigate the expression and detection of B-cell specific activator protein (BSAP) using a monoclonal anti-Pax5 antibody in feline nHL (FnHL) tissue samples to evaluate its diagnostic relevance as a B-cell marker. A total of 45 FnHL samples in 45 cats were evaluated. B-cell lymphoma was the most common immunophenotype (51.1%) for all the samples and T-cell the most common immunophenotype (64.3%) for the gastrointestinal (GI) form. Pax5 stained 82.6% of all B-cell lymphomas and no expression was found in any of the T-cell lymphomas. Anti-Pax5 antibody staining in FnHL is similar to that reported in human and canine counterparts and may offer an excellent B-cell marker in cats.

Doped and Decorated Carbon Nanomaterials

This work shows the preliminary results concerning to the synthesis or modification of carbon-based nanomaterials by plasma discharge, magnetron sputtering, and chemical vapor deposition methodologies. As a first approach to show the potential of these techniques, scanning electron microscopy analysis was performed in order to verify morphological changes and to proof that it is possible to design the morphology of doped and decorated carbon nanomaterials. In spite of none further characterization was performed, from the discussion of results in literature, it can be suggest that these methods would permit to design novel carbon-based nanomaterials<br />for the energy production and storage, catalytic and photocatalytic processes related with environment and green chemistry applications.

Influence of bioaccessibility of total mercury, methyl-mercury and selenium on the risk/benefit associated to the consumption of raw and cooked blue shark (Prionace glauca)

This study aimed to identify the benefit and risk associated with raw and cooked blue shark consumption taking into account the bioaccessibility of Se, Hg and MeHg, by using in vitro digestion method. Selenium, Hg and MeHg levels were higher in cooked samples, particularly in grilled blue shark. Whereas Se bioaccessibility was above 83% in grilled samples, Hg and MeHg bioaccessibility was lower in grilled samples with values near 50%. In addition, all Se-Health Beneficial Values were negative and the molar MeHg:Se ratios were higher than one. The risk-benefit assessment yielded a maximum consumption of one yearly meal for raw or cooked blue shark, thus emphasizing the need to recommend the consumption of a wider variety of seafood species in a balanced and healthy diet.

Photocatalytic Activity of ZnO-Biochar Hybrid Composites

<span>Photodegradation of methylene blue (MB) was studied on ZnO in presence of home-made biochars </span><span>prepared by different methods. MB photodegradation was performed under UV-visible irradiation to verify </span><span>the scaling-up of ZnO-AC hybrid materials. It was verified that oxygenated surface groups on carbon were </span><span>photochemically active in the photodegradation of MB and a synergy effect between both solids has been </span><span>estimated from the first-order apparent rate-constants. This effect enhances the photoactivity of ZnO up to </span><span>a factor about 2.5 and the difference in photoactivity in the binary materials was associated to the surface </span><span>properties of AC.</span>

Influence of anatase and rutile phase in TiO2 upon the photocatalytic degradation of methylene blue under solar irradiation in presence of activated carbon

The influence of activated carbon (AC) on the photocatalytic activity of different crystalline TiO2 phases was verified in the photocatalytic degradation of methylene blue under UV and solar irradiation. The results showed a volcano trend with a maximum photoactivity for the crystalline phase ratio of anatase:rutile equal to 80:20 both under UV or solar irradiation. By contrast, in presence of AC the photocatalytic activity of the binary materials of TiO2/AC followed an exponential trend, increasing as a function of the increase in anatase proportion in the TiO2 framework. The increase in the photoactivity of the binary material TiO2/AC relative to neat TiO2 was up to 22 and about 17 times higher under UV and visible irradiation, respectively. The present results suggest that AC interacts more efficiently with anatase phase than with rutile phase.

[Milbemycinoxime intoxication in a Miniature Australian Shepherd dog]

A 3-year-old female intact Miniature Australian Shepherd presented with convulsive status epilepticus after milbemycinoxime administration in the recommended dosage. In addition to continuous intravenous antiepileptic therapy the dog had to be ventilated for 36 hours due to aspiration pneumonia. After extubation control of intermittent tonic-clonic seizures required a constant-rate-infusion of propofol for another 96 hours, before it could be discontinued on day 5. The patient had fully recovered by day 10. The dog was known to be homozygous for the MDR1-gene mutation. So far milbemycinoxime was regarded a save drug in MDR1-deficient dogs. However, the present case suggests using the lowest possible dosage in MDR1-deficient dogs and pet owners should be advised of potential complications.

In situ coarsening study of inverse micelle-prepared Pt nanoparticles supported on γ-Al2O3: pretreatment and environmental effects

The thermal stability of inverse micelle prepared Pt nanoparticles (NPs) supported on nanocrystalline γ-Al(2)O(3) was monitored in situ under different chemical environments (H(2), O(2), H(2)O) via extended X-ray absorption fine-structure spectroscopy (EXAFS) and ex situ via scanning transmission electron microscopy (STEM). Drastic differences in the stability of identically synthesized NP samples were observed upon exposure to two different pre-treatments. In particular, exposure to O(2) at 400 °C before high temperature annealing in H(2) (800 °C) was found to result in the stabilization of the inverse micelle prepared Pt NPs, reaching a maximum overall size after moderate coarsening of ∼1 nm. Interestingly, when an analogous sample was pre-treated in H(2) at ∼400 °C, a final size of ∼5 nm was reached at 800 °C. The beneficial role of oxygen in the stabilization of small Pt NPs was also observed in situ during annealing treatments in O(2) at 450 °C for several hours. In particular, while NPs of 0.5 ± 0.1 nm initial average size did not display any significant sintering (0.6 ± 0.2 nm final size), an analogous thermal treatment in hydrogen leads to NP coarsening (1.2 ± 0.3 nm). The same sample pre-dosed and annealed in an atmosphere containing water only displayed moderate sintering (0.8 ± 0.3 nm). Our data suggest that PtO(x) species, possibly modifying the NP/support interface, play a role in the stabilization of small Pt NPs. Our study reveals the enhanced thermal stability of inverse micelle prepared Pt NPs and the importance of the sample pre-treatment and annealing environment in the minimization of undesired sintering processes affecting the catalytic performance of nanosized particles.

Assessing the environmental performance of urban wastewater systems using the INSA model: application to the Algés-Alcântara wastewater system, in Portugal

Although the application of complex integrated models to wastewater systems is useful, it is often difficult to implement and not always suitable for the design of new systems or for their rehabilitation. Integrated simple approaches that allow assessing the environmental performance of urban wastewater systems may be advantageous, especially during the initial phases of the system planning process. This paper presents an original, straightforward approach that can be used for planning, design and operation of urban wastewater systems. The INtegrated Simplified Approach (INSA) combines the concepts of performance indicators with mass balances and can be applied to wastewater systems as a management support tool, particularly in situations where there is lack of data, economic limitations or time constraints. The INSA was applied to the Algés-Alcântara wastewater system to evaluate its environmental performance and to simulate the individual or combined impact of the rehabilitation measures proposed, thus defining their priority. The results clearly indicate that, despite the investment already made upgrading the wastewater treatment plant (WWTP), the proposed interventions must be implemented to ensure an acceptable environmental performance of the system. In addition, the results demonstrate the significant pollution loads present in stormwater, frequently higher than the pollution loads discharged into receiving waters during dry weather.

Risk estimates for persistent high-risk human papillomavirus infections as surrogate endpoints of progressive cervical disease critically depend on reference category: analysis of the combined prospective cohort of the New Independent States of the Former Soviet Union and Latin American Screening Studies

Summary

To make feasible future clinical trials with new-generation human papillomavirus (HPV) vaccines, novel virological surrogate endpoints of progressive disease have been proposed, including high-risk HPV (HR-HPV) persistence for six months (6M+) or 12 months (12M+). The risk estimates (relative risks [RRs]) of these ‘virological endpoints’ are influenced by several variables, not yet validated adequately. We compared the impact of three referent groups: (i) HPV-negative, (ii) HPV-transient, (iii) HPV-mixed outcome on the risk estimates for 6M+ or 12M+ HR-HPV persistence as predictors of progressive disease. Generalized estimating equation models were used to estimate the strength of 6M+ and 12M+ HR-HPV persistence with disease progression to squamous intraepithelial lesions (SILs), cervical intraepithelial neoplasia (CIN) grade 1 +, CIN2+, CIN/SIL endpoints, comparing three optional reference categories (i)-(iii) in a prospective sub-cohort of 1865 women from the combined New Independent States of the Former Soviet Union (NIS) and Latin American Screening (LAMS) studies cohort ( n = 15,301). The RRs of these viral endpoints as predictors of progressive disease are affected by the length of viral persistence (6M+ or 12M+) and the surrogate endpoint (SIL, CIN1, CIN2, CIN/SIL). Most dramatic is the effect of the referent group used in risk estimates, with the HPV-negative referent group giving the highest and most consistent RRs for both 6M+ and 12M+ viral persistence, irrespective of which surrogate is used. In addition to deciding on whether to use 6M+ or 12M+ persistence criteria, and cytological, histological or combined surrogate endpoints, one should adopt the HPV-negative referent group as the gold standard in all future studies using viral persistence as the surrogate endpoint of progressive disease.

Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study

OBJECTIVES

To assess whether human papillomavirus (HPV) testing is a safe enough approach to warrant extension of the screening intervals of baseline Papanicolaou (Pap)-/HPV- women in low-income settings.

METHODS

Of the >1000 women prospectively followed up as part of the Latin American Screening (LAMS) Study in São Paulo, Campinas, Porto Alegre) and Buenos Aires, 470 women with both baseline cytology and Hybrid Capture 2 (HC2) results available were included in this analysis. These baseline Pap-negative and HC2- or HC2+ women were controlled at six-month intervals with colposcopy, HC2 and Pap to assess the cumulative risk of incident Pap smear abnormalities and their predictive factors.

RESULTS

Of the 470 women, 324 (68.9%) were high-risk HPV (hrHPV) positive and 146 (31.1%) were negative. Having two or more lifetime sex partners (odds ratio [OR] = 2.63; 95% CI 1.70-3.51) and women using hormonal contraception (OR = 2.21; 95% CI 1.40-3.51) were at increased risk for baseline hrHPV infection. Baseline hrHPV+ women had a significantly increased risk of incident abnormal Pap smears during the follow-up. Survival curves deviate from each other starting at month 24 onwards, when hrHPV+ women start rapidly accumulating incident Pap smear abnormalities, including atypical squamous cells (ASC) or worse (log-rank; P < 0.001), low-grade squamous intraepithelial lesions (LSIL) or worse (P < 0.001) and high-grade squamous intraepithelial lesions (HSIL) (P = 0.03). Among the baseline hrHPV- women, the acquisition of incident hrHPV during the follow-up period significantly increased the risk of incident cytological abnormalities (hazard ratio = 3.5; 95% CI 1.1-11.7).

CONCLUSION

These data implicate that HPV testing for hrHPV types might be a safe enough approach to warrant extension of the screening interval of hrHPV-/Pap-women even in low-resource settings. Although some women will inevitably contract hrHPV, the process to develop HSIL will be long enough to enable their detection at the next screening round (e.g. after three years).

Drug addiction is not an independent risk factor for oncogenic human papillomavirus infections or high-grade cervical intraepithelial neoplasia: case-control study nested within the Latin American Screening study cohort

Drug abuse (addiction) has been listed among the risk factors for human papillomavirus (HPV) infections, but no case-control studies exist to rule out sexual behaviour and other potential confounders. The aim of this study is to evaluate the role of drug addiction as an independent predictor of HR-HPV infections and (cervical intraepithelial neoplasia) CIN2+ in an age-matched case-control (1:4) study nested within the prospective Latin American Screening (LAMS) study cohort. All 109 women in the LAMS cohort (n = 12,114) reporting drug abuse/addiction were matched with four controls (n = 436) of non-abusers strictly by age. Conditional logistic regression analysis was used to estimate the co-variates of drug abuse, and the whole series (n = 545) was analysed for predictors of HR-HPV and CIN2+ using univariate and multivariate regression models. Oncogenic HPV infections were significantly (P = 0.019) more prevalent among abusers (37.7%) than in controls (21.9%), but there was no difference in high-grade squamous intraepithelial lesions (P = 0.180) or CIN2+ lesions (P = 0.201). In multivariate conditional logistic regression, number of lifetime sexual partners (P = 0.0001), ever smokers (P = 0.0001), non-use of OCs (P = 0.013), ever having sexually transmitted diseases (STD) (P = 0.041) and no previous Pap smear (P = 0.027) were independent co-variates of drug addiction. Drug abuse was not an independent risk factor of high-risk (HR)-HPV infection, which was significantly predicted by (1) age below 30 years (P = 0.045), (2) more than five lifetime sexual partners (P = 0.046) and (3) being current smoker (P = 0.0001). In multivariate model, only HR-HPV infection was an independent risk factor of CIN2+ (P = 0.031), with adjusted OR = 11.33 (95% CI 1.25–102.50). These data indicate that drug addiction is not an independent risk factor of either HR-HPV infections or CIN2+, but the increased prevalence of HR-HPV infections is explained by the high-risk sexual behaviour and smoking habits of these women.

Self-sampling for human papillomavirus (HPV) testing as cervical cancer screening option. Experience from the LAMS study

PURPOSE

To compare Hybrid Capture II (HC2) in detecting high-risk (HR) HPV in patient-collected vaginal samples with those obtained using gynaecologist collected samples.

METHODS

Patients were submitted to Pap smears, visual inspection with acetic acid (VIA) and HC2 for hr-HPV.

RESULTS

A total of 1,081 HC2 tests for HR-HPV were performed: 770 (71.2%) samples were collected by a physician and 311 (28.8%) were self-collected by the patients. In detecting any cervical lesion, the sensitivity of HC2 collected by a physician was higher (92.86%) than that (37.5%) in the self-sampling group. Negative predictive value (NPV) was high for both, 99.69% and 93.75%, respectively. Using the CIN2 cutoff, performance of HC2 was significantly improved: 92.9% and 62.5%, respectively. HC2 specificity for any cervical lesion and for CIN2 or higher were close to 90% in both groups.

CONCLUSIONS

Self-sampled HPV testing is a powerful option to increase the detection of cervical lesions in women segregated from prevention programs.

Human papillomavirus testing as an optional screening tool in low-resource settings of Latin America: experience from the Latin American Screening study

Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] = 1.31; 95% CI 1.1-1.6), in women with two or more lifetime sexual partners (OR = 1.9; 95% CI 1.6-2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR = 1.6; 95% CI 1.2-2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P= 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9-86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease.

Human papillomavirus testing as an optional screening tool in low-resource settings of Latin America: experience from the Latin American Screening study

Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] = 1.31; 95% CI 1.1–1.6), in women with two or more lifetime sexual partners (OR = 1.9; 95% CI 1.6–2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR = 1.6; 95% CI 1.2–2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P = 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9–86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease.

Factors predicting intermediate endpoints of cervical cancer and exposure to human papillomavirus (HPV) infections in young women screened as potential targets for prophylactic HPV vaccination in south of Brazil

OBJECTIVE

To explore the predictors of intermediate endpoints of cervical cancer in 500 women living in Porto Alegre.

STUDY DESIGN

Five hundred randomly selected women (mean age 20.3 years, range 15-25) were screened using PCR detecting 25 HPV types (HPV6, 11, 16, 18, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 70, and 74). Women were interviewed and serum samples were analysed for antibodies to HPV16 and HPV18 VLPs. Regression models were constructed to analyse predictive factors for (a) HPV PCR status, (b) HPV16-seropositivity, (c) HPV18-seropositivity, and (d) SIL in the PAP smear, used as intermediate endpoints of cervical cancer.

RESULTS

Specific HPV types were identified in 137 (27.4%) of the 157 (31.4%) PCR-positive women. PAP test result was the most powerful independent predictor of HPV status in PCR (p = 0.0001), followed by the sexual activity started (p = 0.001) (adjusted OR 34.075, 95% CI: 4.650-249.715). PAP test SIL was independently predicted only by the HPV PCR status (p = 0.0001) (OR 7.561, 95% CI: 2.787-20.514). HPV16 and HPV18 serostatus were the most significant predictors of each other (p=0.0001), and the life-time number of sexual partners was more significant (p=0.001) predictor of HPV16 than HPV18 serostatus (p = 0.049).

CONCLUSION

These data are useful in evaluating the exposure status of the women to the risk factors of cervical cancer in south of Brazil.

Evaluation of visual inspection with acetic acid (VIA), Lugol's iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America. This report refers to partial results from the LAMS (Latin AMerican Screening) study

OBJECTIVES

To assess the performance indicators of visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) in four Latin American centres participating in the ongoing Latin AMerican Screening (LAMS) study, in settings with moderate incidence of cervical disease and with poorly to moderately well-organized cervical cancer screening.

SETTING

Three Brazilian centres (São Paulo, Campinas and Porto Alegre) and one Argentine centre (Buenos Aires) recruited a total of 11,834 healthy women to undergo VIA, VILI, conventional Pap smear and Hybrid Capture II (HCII).

METHODS

Women who had a positive result from any of these tests were subjected to colposcopy and biopsies (if necessary), and women with high-grade cervical intraepithelial neoplasia (CIN) were properly treated. To control for verification bias, 5% of women with normal tests were referred for colposcopy, as were 20% of HCII-negative women.

RESULTS

Data on VIA (n=11,834), VILI (n=2994), conventional Pap smear (n=10,138) and HCII (n=4195) were available for test comparisons, calculating sensitivity, specificity, and positive and negative predictive values. Overall test positivity was 11.6% for VIA, 23.0% for VILI, 2.2% for Pap smear (LSIL threshold), 1.1% for Pap smear (HSIL threshold) and 17.1% for HCII. VIA was positive in 61.8% of the women with CIN 1, 57.0% of those with CIN 2, 35.0% of women with CIN 3 and in 21 of 28 (75%) of women with cancer. Approximately 10% of women with no detectable disease had an abnormal VIA. Regarding VILI, 83.3% of women diagnosed with CIN 1 and 62.5% of those with CIN 3 had an abnormal test. VILI failed to detect one of three cases of cancer. Both the sensitivity, specificity and positive predictive value of VIA and VILI in detecting CIN 2 or CIN 3 could be significantly improved depending on the combination with Pap smear or HCII (sensitivity up to 100.0% and specificity up to 99.8%).

CONCLUSIONS

The LAMS study failed to reproduce the performance figures obtained with VIA and VILI (as stand-alone tests) in some other settings, where the prevalence of cervical disease was higher. However, a combined use of VIA or VILI with the Pap test or HCII allowed specific detection of cervical abnormalities.

Comparing PAP smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America. Study design and baseline data of the LAMS study

OBJECTIVES

This is a European Commission (EC)-funded ongoing study known as the LAMS (Latin American Screening) study, where PAP smear/liquid-based cytology and screening colposcopy were compared with i) three optional screening tools [visual inspection with acetic acid (VIA), or Lugol's iodine (VILI), cervicography] and with ii) Hybrid Capture II from a) conventional samples and from b) self-samples, in women at different risk for cervical cancer in Brazil and Argentina.

STUDY DESIGN

During 2002-2003, a cohort of 12,107 women attending four clinics: Campinas (CA), Sao Paulo (SP), Porto Alegre (PA) and Buenos Aires (BA), were interviewed for risk factors, and examined using the 8 diagnostic arms. Colposcopy was performed for women positive in any test and for 5% of women with baseline PAP-negative and 20% of HCII-negatives. All high-grade lesions (CIN2/3) were treated, and low-grade CIN are prospectively followed-up.

RESULTS

Of the 12,107 women, the following baseline data are available: epidemiological data (n=11,996), conventional PAP smears (n=10,363), LBC, SurePATH (n=320), LBC, DNA-Citoliq (n=1,346), VIA (n=12.067), VILI (n=3,061), cervicography (n=279), screening colposcopy (n=3,437), HCII conventional (n=4,710), HCII self-sampling (n=246) and cervical biopsies (n=1,524). The four sub-cohorts differ significantly in all their baseline data on the implicated risk factors of cervical cancer, consonant with their origin from regions with different cancer incidence. Around 95% of all PAP smears were negative, with slight variations in the prevalence of LSIL and HSIL between the four centers. Significant differences were found in the detection rates of abnormal findings in VIA, VILI and colposcopy between the four centers (p=0.0001). The prevalence of HPV was practically identical (16.5-18.8%) in all four cohorts (p=0.486), with no differences in the relative viral loads. Biopsy results were different depending on whether the women underwent screening colposcopy (BA) or elective colposcopy (others).

CONCLUSION

Four cohorts with significantly different baseline data are available, and prospective follow-up of these women permits analysis of whether variations in cervical cancer incidence in these regions is due to i) different natural history of the precursor lesions, or ii) due to different levels of exposure to the known risk factors.

Sustainable sewage solutions for small agglomerations

In a significant number of European countries, the need for providing appropriate treatment for the effluents of small rural communities is still especially relevant. In fact, in countries like Portugal, Spain, and many others, significant amounts of investment will be addressed in the next few years to the construction of small Wastewater Treatment Plants (WWTP). The problems faced when constructing and operating WWTP serving small communities may be relevant when energy and labour costs are relatively high, or when the visual impact on the surrounding areas is especially negative. Sustainable treatment solutions require the selection of appropriate technologies using fewer resources. In this paper, information is presented about sustainability indicators of twenty-one small secondary wastewater treatment plants, including conventional (trickling filters and extended aeration plants) and non-conventional treatment systems (constructed wetlands). The data refer to allocated areas per inhabitant, amounts of concrete per inhabitant, power per inhabitant, and construction and installation costs per inhabitant. The data seem to show that for different reasons, constructed wetlands are promising treatment solutions for application to rural areas in particular because of the relatively low power requirements and relatively low construction costs for served populations below 500 inhabitants.

Modelling in-sewer pollutant degradation processes in the Costa do Estoril sewer system

Characteristics of wastewater vary during transportation through sewer systems as a result of a number of processes. Under aerobic conditions, in long sewer systems, the reduction of the BOD or COD may be similar to the reduction obtained in conventional primary settling tanks. The mathematical model that was developed is based on a number of different existing models: the ASM n. 1 and ASM n. 2 models, the AEROSEPT model and the WATS model. The model also includes a prediction of reaeration at falls. The module of the anoxic conditions was adapted from the ASM n. 2 model. This module is a first attempt to model the degradation of organic matter in sewer systems under anoxic conditions. The mathematical model was applied to the Costa do Estoril intercepting sewer, and the obtained results are discussed taken into account the experimental data that was collected during a three-month period. Average removals of dissolved COD over 20% have been obtained. In the paper special emphasis is given to the importance of the performance of the Costa do Estoril sewer system as a biological reactor.

Primary structure deduction and molecular modelling from a cDNA of a cellobiohydrolase-like protein from the white-rot fungus Coriolus versicolor

Molecular cloning and cDNA sequencing analysis were used to elucidate the primary structure of a cellulase-like structure from the white-rot fungus Coriolus versicolor. The cDNA of interest was isolated from a cDNA library obtained from C. versicolor mycelia grown on cellulase inducer medium. A pattern search showed that this cellulase belongs to the glycosyl hydrolases family 6. From the deduced amino acid sequence, models of the binding and catalytic domains were built by homology modelling. The constructed models present a typical cellulose-binding domain at the N-terminal region, a rich Pro, Ser, Thr linker peptide, and a catalytic domain at the C-terminus region.

Cervical Cancer Screening in Porto Alegre, Brazil: Alternative Methods for Detecting Cancer Precursors in a Developing Country

OBJECTIVE

This study was conducted to test the performance characteristics of cervical cancer screening by visual inspection of the cervix with acetic acid and iodine solution.

METHODS

A total of 100 women were screened for cervical cancer by Pap smear and naked eye inspection of the cervix after application of acetic acid and iodine solution.

RESULTS

Comparing visual inspection to the Pap test, a sensitivity of 85.7%, specificity of 78.5%, and concordance of 79% (p < .0011) was established. Comparing the Pap test with colposcopy, the corresponding figures were 42.9%, 92.3%, and 66.6% (p < .077), respectively. Visual inspection compared to colposcopy showed corresponding figures of 100%, 7.7%, and 55.5% (p = .48), respectively. Colposcopy and biopsy had an agreement of 100%.

CONCLUSIONS

Visual inspection with acetic acid and iodine solution proved to be a reasonable method of screening for cervical cancer precursors.

A randomized, placebo-controlled trial of granulocyte-macrophage colony-stimulating factor and nucleoside analogue therapy in AIDS

Preliminary preclinical and clinical data suggest that granulocyte-macrophage colony-stimulating factor (GM-CSF) may decrease viral replication. Therefore, 105 individuals with AIDS who were receiving nucleoside analogue therapy were enrolled in a placebo-controlled, double-blind study and were randomized to receive either 125 microgram/m(2) of yeast-derived, GM-CSF (sargramostim) or placebo subcutaneously twice weekly for 6 months. Subjects were evaluated for toxicity and disease progression. A significant decrease in mean virus load (VL) was observed for the GM-CSF treatment group at 6 months (-0.07 log(10) vs. -0.60 log(10); P=.02). More subjects achieved human immunodeficiency virus (HIV)-RNA levels <500 copies/mL at >/=2 evaluations (2% on placebo vs. 11% on GM-CSF; P=.04). Genotypic analysis of 46 subjects demonstrated a lower frequency of zidovudine-resistant mutations among those receiving GM-CSF (80% vs. 50%; P=.04). No difference was observed in the incidence of opportunistic infections (OIs) through 6 months or survival, despite a higher risk for OI among GM-CSF recipients. GM-CSF reduced VL and limited the evolution of zidovudine-resistant genotypes, potentially providing adjunctive therapy in HIV disease.