Increase in the influenza vaccination rates in Portugal: comparing 2020-2021 to the last 10 years

Background

Annual influenza vaccine uptake is recommended by the Portuguese General-Directorate of Health to certain priority groups. In 2020, amidst the COVID-19 pandemic, some exceptional measures were adopted to operationalize the Portuguese influenza vaccination campaign, like the extension and phasing of the vaccination period. No major changes were introduced in the vaccination of healthcare workers. In Baixo Tâmega health cluster (Portugal), it was perceived that these workers' vaccine uptake had markedly increased in 2020-2021. This study aims to compare their influenza vaccination coverage rates in 2020-2021 to the last 10 seasons.

Methods

A cross-sectional study of the vaccine uptake among the health workers of Baixo Tâmega health cluster was developed. A descriptive analysis was carried out, calculating annual influenza vaccination coverage rates from 2010-2011 to 2020-2021, in doctors, nurses and other health workers. Inferential analysis was performed through chi-squared tests in IBM SPSS Statistics 27.0.1.0., considering significant p-values<0.05.

Results

The difference between health workers 2020-2021's influenza coverage rate and the last season's average rates was 22.81%. Before 2020-2021, average vaccination coverage rates were 51.60% (standard deviation 7.34%, 44.26-58.94%), 60.44% (standard deviation 4.12%, 56.32-64.56%) and 51.20% (standard deviation 7.66%, 43.54-58.86%), in doctors, nurses and other health workers, respectively. In 2020-2021, vaccination rates significantly increased to 79.34%, 79.52% and 74.24% in doctors, nurses and others, respectively (p < 0.001).

Conclusions

Influenza vaccination uptake increased in 2020-2021 among health workers. Further studies should be developed to evaluate this tendency on a larger scale and to better understand its associated factors, which could have been unstructured awareness-raising campaigns, perception of protection against COVID-19 or avoidance of COVID-19-like symptoms and coinfection.

Key messages

Influenza vaccination coverage rates increased in 2020-2021 among the healthcare workers of a Portuguese health cluster. The COVID-19 pandemic may have contributed to the increase in the influenza vaccination coverage rates.

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS

Objective

To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.

Methods

This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.

Results

On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.

Conclusion

Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

Strategies to empower socially vulnerable adolescents in Brazil

Brazil has the highest number of adolescents murdered in the world. An alarming number of these are black boys from deprived backgrounds living in the outskirts of big cities. At schools, teachers play an important role in promoting health. Thus, the University of Brasília through its Public Health Research Group has developed the training course “Strategies to empower socially vulnerable adolescents” (JAVU in Portuguese) aimed primarily at state school teachers from municipalities where social vulnerability among teenagers is either high or very high.

It is a 180-hour, 10-module distance learning course with tutor supervision which aims at contributing to the development of an inclusive and emancipating culture which is non-discriminatory, diversified and which promotes peace in school settings. Its innovative aspect is the use of the platform JAVU Topography, a catalogue of policies, programmes and services aimed at public health and education at municipal, state and federal level. By the end of the course teachers create a diagnosis that measures the extent to which these different policies or services can be applied in different educational settings to promote health.

From November 2019 to March 2020, 2953 teachers underwent training. The majority were: women (83.6%); pardos (50.2%) - a mixed race/ethnicity in former Portuguese and Spanish colonies; postgraduates (50.6%); catholic (42.6%) and earning between 1 to 3 minimum salaries (49.4%). Having access to the JAVU Topography helped make this tool a platform to spread social protection in Brazil. The theoretical and practical support is one of the main contributions of this course to actions that address health problems among adolescents.

The course formed teachers from 42 of the most vulnerable cities in Brazil, enabling access to a network of protection and allowing for the exchange of experiences through the educational platform, which better equipped these teachers to promote health in the educational setting.

Key messages

Improving the promotion of health among socially vulnerable adolescents in Brazil in their school settings. Raising awareness of networks of social protection though a social topography that aims at empowering socially vulnerable adolescents in Brazil.

Customization and external validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) in Brazilian critically ill patients

PURPOSE

To customize and externally validate the recently proposed Simplified Mortality Score for the ICU (SMS-ICU, a simple score for 90-day mortality that has no need for ancillary testing results) for in-hospital mortality and to compare its performance to SAPS 3.

MATERIAL AND METHODS

We used data from two distinct large cohorts of adult Brazilian patients with unplanned ICU admissions to perform a first-level customization (43,017 patients admitted to 78 ICUs) of the original SMS-ICU score for in-hospital mortality and, sequentially, externally validate it (313,365 patients admitted to 99 ICUs). Performance of SMS-ICU was assessed through measurements of discrimination and calibration and compared with SAPS 3.

RESULTS

In the validation cohort, median SMS-ICU was 13 (IQR 8-16) points and median SAPS 3 was 44 (IQR 36-51). Discrimination of SMS-ICU was good (AUC 0.817; 95% CI 0.814-0.819) but slightly lower than of SAPS 3 (AUC 0.845; 95% CI 0.843-0.848;). The customized SMS-ICU predictions were comparable to SAPS 3 in terms of calibration.

CONCLUSION

In this external validation of the SMS-ICU in a large Brazilian cohort, we observed good discrimination of SMS-ICU and acceptable calibration after first-level customization. SMS-ICU can be used as a measure of illness severity for acutely admitted ICU patients in clinical studies.

Abstract P1-15-19: Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients

Background

The addition of carboplatin to an anthracycline/taxane-based chemotherapy(CT) in neoadjuvant setting has been suggested to improve pathological complete response(pCR) in TNBC. However, the impact of pCR in prognosis is unknown. We aim to study the value and feasibility of the addition of carboplatin in neoadjuvant setting.

Methods

Demographic and clinical data of TNBC patients treated with neoadjuvant CT in a comprehensive cancer center between 2010-2018 were retrospectively collected. Two cohorts were defined: one treated with Carboplatin/Paclitaxel followed by dose-dense Doxorrubicin/Cyclophosphamide(CP-AC) and other with AC followed by Docetaxel(AC-D). Median follow-up time was 3.1 and 6.9 years, respectively. pCR was defined as absence of residual invasive tumor in breast/axilla. Survival analysis using Kaplan-Meier method and Cox proportional-hazards model were applied. Statistical significance was set at p&lt;0.05.

Results

One-hundred and sixty patients were enrolled: 78 CP-AC and 38 AC-D. Groups were balanced regarding patients and tumor characteristics with exception of pre-menopausal status, more frequent in CP-AC(68% vs 47%;p=.04). Age at diagnosis was 47(28-76)years, the majority had ECOG 0(92%) ductal carcinomas(82%), clinicalT2/3 stages(76%), grade 3(81%) with lymph node involvement(N+)(57%). 14% had Inflammatory breast cancer(IBC)(CP-AC 14%;AC-D 13%; p=.9).

Neutropenia was the most prevalent adverse event(G3/4: CP-AC 61%;AC-D 16%;p=.02), 12% and 16% of febrile neutropenia(p=.8). G3/4 thrombocytopenia occurred only in CP-AC(6%). Hypersensitivity reactions were more prevalent in CP-AC(19% vs 2.7%;p=.02), majority to paclitaxel, all G1/2. Hospital admission occurred in 12%(CP-AC 13%;AC-D 9%; p=.8). There were no treatment-related deaths. Treatment schedule was complete in 89%(CP-AC 87%;AC-D 92%;p=.5), with 20% dose reductions(CP-AC 25%;AC-D 11%;p=0.9).

pCR was achieved in 42%(CP-AC 50%;AC-D 28%;p=.03). 1- and 3-year disease-free survival(DFS) was 94%/85% for CP-AC and 72%/58% for AC-D(p=.3). Risk of recurrence was higher in IBC(HR 25.1;CI95% 7.7-81.3;p&lt;.0001), N+ disease(HR 3.6;CI95% 1.2-10.5;p=.02) and non-pCR(HR 10.9;CI95% 2.3-52.3,p=.003). N+ disease was associated with higher recurrence only in AC-D(HR 11.7;CI95% 1.3-104;p=.03).

Cancer-related deaths were 20%(CP-AC 10%;AC-D 40%;p=.001). 1- and 2-year overall survival (OS) was 99%/95% for CP-AC and 70%/61% for AC-D(p=.06). N+ disease was associated with higher risk of death in AC-D(HR 6.3;CI95% 1.1-24.6;p=.04). Risk of death was independently associated with IBC(HR 4.1;CI95% 2.1-18.7; p=.001) but not with N+ disease(HR 2.7;CI95% 0.8-9.5;p=.13) or pCR(HR 4.1;CI95% 0.9-19.7;p=.08) although pCR was statistically significant in univariate analysis (1- and 2-year OS 97% vs 92% and 94% vs 86% for pCR and non-PCR;p=.003).

Conclusions

Carboplatin addition clearly increased pCR with a trend to DFS and OS benefit. This regimen was associated with more, nevertheless manageable, adverse events with most of the patients able to tolerate and complete the full-dose regimen. Though we did not find a subgroup of patients that benefit with carboplatin regimen, we should consider avoiding AC-D at least in N+ disease.

Citation Format: Coelho S, Abreu MH, Sales C, Lopes AR, Sousa MF, Couto R, Pousa I, Ferreira A, Ferreira M, Vieira C, Leal C, Castro F, Sousa S, Pereira D. Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-19.

In vitro expansion of human cardiac progenitor cells: exploring 'omics tools for characterization of cell-based allogeneic products

Human cardiac stem/progenitor cells (hCPCs) have been shown to be capable to regenerate contractile myocardium. However, because of their relative low abundance in the heart, in vitro expansion of hCPC is mandatory to achieve necessary quantities for allogeneic or autologous cardiac regeneration therapy applications (10(6)-10(9) cells/patient). Up to now, cell number requirements of ongoing phase I/IIa trials have been fulfilled with production in static monolayer cultures. However, this manufacturing process poses critical limitations when moving to the following clinical phases where hundreds of patients will be enrolled. For this, increased process yield is required, while guaranteeing the quality of the cell-based products. In this work, we developed and validated a robust, scalable, and good manufacturing practice (GMP)-compatible bioprocess for the expansion of high-quality hCPC. We applied platforms extensively used by the biopharmaceutical industry, such as microcarrier technology and stirred systems, and assessed culture conditions' impact on hCPC's quality and potency, as required by regulatory agencies. Complementary analytical assays including gene expression microarrays and mass spectrometry-based approaches were explored to compare transcriptome, proteome, surface markers, and secretion profiles of hCPC cultured in static monolayers and in stirred microcarrier-based systems. Our results show that stirred microcarrier-based culture systems enabled achieving more than 3-fold increase in hCPC expansion, when compared with traditional static monolayers, while retaining cell's phenotype and similar "omics" profiles. These findings demonstrate that this change in the production process does not affect cell's identity and quality, with potential to be translated into a transversal production platform for clinical development of stem-cell therapies.

Evaluation of alternative schemes for recording body weights in meat-type quails by using random regression

Data from 8759 meat-type quails from the UFV1 strain and 9128 from the UFV2 strain were used to assess the possibility of reducing the number of body weight records in genetic evaluations. The evaluated animals were weighed weekly since hatching to the 6th week of life, with up to 7 records of body weight for each bird. The data were evaluated by random regression models, with 9 alternative schemes of data recording, which included 4 records for each scheme and their covariance functions for additive and permanent environmental effects of order 3, fitting 4 intervals for residual variance, and a complete scheme, with 7 records, order of fit 6 for additive and permanent environmental effects and 7 intervals for residual variance. Estimates of heritability for body weight at the 6th week varied from 0.45 to 0.53 for the UFV1 strain and from 0.28 to 0.54 for UFV2 strain. The schemes that had more records in points at the final extreme of the age range showed better estimates, which was likely due to certain properties of polynomial regression that led to biased results in the final extreme of the age range when data are unbalanced. The reduction of the number of body weight records taken during the growth phase is feasible, with little change to breeding value estimates, when 4 body weight records are used in random regression models.

Anticonvulsant properties of N-salicyloyltryptamine in mice

A new tryptamine analogue, N-salicyloyltryptamine (STP), a potential central nervous system (CNS) depressant, was tested in the pentylenetetrazol (PTZ) and maximal electroshock (MES) models of epilepsy in mice. When administered concurrently, STP (100 mg/kg ip) significantly reduced the number of animals that exhibited PTZ-induced seizures and eliminated the extensor reflex of maximal electric-induced seizures test in 50% of the experimental animals. In addition, it showed protection in the PTZ test by diminishing the death rate.

Rapid weight gain, at least in some women, is an expression of a neuroendocrine state characterized by reduced hypothalamic dopaminergic tone

A group of 17 consecutive regularly menstruating women who gained at least 5 kg the previous year (Group 1) was compared with a control group of similar age, parity and social class (Group 2). Galactorrhea was observed in 6/17 women from group 1 and in 1/16 women from group 2 (chi 2 4.571; p < .05). Average morning prolactin levels were higher in group 1 (8.15 +/- 4.92 micrograms/l) than in group 2 (5.29 +/- 2.48 micrograms/l; p < .05). The two groups were similar in their morning thyroxin, triiodothyronine, TSH, estradiol, cortisol, gastrin, cholecystokinin, somatostatin, oxytocin, insulin and IGF-1 levels. Leptin levels were significantly higher in group 1 than in group 2 (18.85 +/- 10.63 micrograms/l vs. 10.15 +/- 6.38 micrograms/l; p < .02) but this difference could be attributed exclusively to the higher body mass index (BMI) of group 1 (MANCOVA). Analysis of the distribution of basal prolactin levels in group 1 revealed a skewed distribution due to the presence of six outliers (Barnett and Lewis test associated with Mahalanobis distance) whose values were higher than the highest value found in group 2. These outliers were henceforth considered as subgroup 1a, and the remnant patients in group 1 as subgroup 1b. Besides the expected difference in basal prolactin levels between subgroups 1a and 1b (13.72 +/- 3.69 and 5.12 +/- 1.81 micrograms/l, respectively) and the higher frequency of galactorrhea in group 1a (4/6 vs. 2/11; p < .05) no other differences were observed in clinical or basal biochemical parameters. Following domperidone (10 mg, i.v.) the percentual increase in prolactin (delta Prl 20'/Prl 0') was significantly lower in group 1 than in group 2 (23.9 + 15.2 vs. 37.0 +/- 21.2; p < .05). In absolute values, the prolactin rise in subgroup 1a (100.7 +/- 45.5 micrograms/l) was significantly lower (p < .02) than that of subgroup 1b (157.3 +/- 50.3 micrograms/l) and group 2 (152.7 +/- 34.5 micrograms/l). Group 1 (and each one of its two sub-groups) also differed from group 2 in a higher incidence of meaningful life-events the year preceding the study. This study confirms previous observations that recent weight gain in women is preceded by important life-events and is associated with galactorrhea and increased prolactin levels in a number of them. Besides, it provides evidence that the increased prolactin levels are due to reduced hypothalamic dopaminergic tone.

Calcium beta-hydroxy-beta-methylbutyrate. 1. Potential role as a phosphate binder in uremia: in vitro study

The binding capacity of calcium beta-hydroxy-beta-methylbutyrate (calcium HMB), compared to other binders, was investigated in an in vitro study. Fifty milliequivalents of either calcium HMB, calcium acetate, calcium carbonate, aluminum hydroxide gel or non-gel aluminum hydroxide was added to a phosphate solution, titrated (HCl or NaOH), shaken and centrifuged to four different pH levels at 37 degrees C (simulating the gastrointestinal milieu). The difference in phosphate concentration between that of the initial and that of the supernatant represented from the bound phosphate in the precipitate. After 4 h at a pH of 6 (representing the intestinal condition after a meal), the binding percentage was: calcium acetate = 95.6%, calcium HMB = 92.6%, calcium carbonate = 46.4%, aluminum hydroxide gel = 33.4% and non-gel aluminum hydroxide = 17.8%. There was no significant difference (p > 0.05) between calcium HMB and calcium acetate. These results suggest that calcium HMB is an efficient phosphate binder in vitro, which may predict its effective role in vivo.

Endocrine and psychological evaluation of women with recent weight gain

A group of 13 consecutive regularly menstruating women who gained at least 5 kg the previous year (Group I) was compared to a control group of similar age, parity, and social class (Group II). The two groups were similar in estimated and observed food intakes; pre- and postprandial gastrin levels; hourly 24-h profiles of cortisol and insulin; urinary cortisol and 17-hydroxycorticosteroids. Group I had higher serum prolactin concentrations at all times than Group II (mean values 14.60 micrograms/l vs. 8.84 micrograms/l; p = .0121). Galactorrhea was observed in 5 women from Group I and in none of the women from Group II (p < .05). Group I also differed from Group II in a higher incidence of meaningful life-events the year preceding the study, higher prevalence of sexual dysfunction (9/13 vs. 4/13; p < .01) and higher indexes (p < .05) of several parameters in the MMPI and SCL 90. Median serum cortisol and prolactin concentrations were negatively correlated, both in Group I (R = -.669; p = .012) and in the whole sample (R = -.453; p = .0298). It is suggested that the rapid weight gain is part of a neuroendocrine response to environmental stimuli also characterized by hyperprolactinemia. The significant negative correlation between serum prolactin and cortisol indicates that this response differs from, and is possibly an alternative to, the sympathoadrenal "stress" response.

Anabolic effects of insulin and amino acids in promoting nitrogen accretion in postoperative patients

The present study evaluates the effect of insulin and amino acids on nitrogen balance in the immediate postoperative period in moderately stressed patients who have undergone major abdominal surgical operations. Patients were randomly assigned into two large groups (n = 16 each) and four subgroups (n = 8 each). Groups ICON and IINS received an infusion of total parenteral nutrition solution containing 0.25 g of nitrogen per kilogram per day with a calorie:nitrogen (C:N) ratio of 150:1. Groups IICON and IIINS received twice the load of nitrogen with a C:N ratio of 75:1. Groups IINS AND IIINS received an additional continuous infusion of insulin at a rate of 1.0 mU/kg per minute for 7 days. During the total parenteral nutrition period, the patients were kept NPO, and 24-hour urine output was collected for estimation of total nitrogen excretion and nitrogen balance. Net nitrogen excretion (grams per kilogram per day) averaged 0.143 +/- 0.06 in IINS and 0.23 +/- 0.08 in ICON (p < .05) and 0.178 +/- 0.6 in IIINS and 0.25 +/- 0.10 in IICON (p < .05). Nitrogen balance (grams per day) was positive in the four groups: +0.65 +/- 3.8 in IINS and +6.74 +/- 2.94 in ICON (p < .05), and +14.4 +/- 2.61 in IIINS and +11.63 +/- 6.44 in IICON (p = not significant). The average nitrogen incorporation (percent per day) was: 41.3 +/- 6.2 in IINS and 14.6 +/- 20.1 in ICON (p < .05), and 58.3 +/- 4.5 in IIINS and 38.7 +/- 26.2 in IICON (p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Is idiopathic hyperprolactinemia a transitional stage toward prolactinoma?

The basal prolactin (PRL) levels on five different days, the PRL responses to thyrotropin-releasing hormone and to domperidone, and the thyroid-stimulating hormone (TSH) responses to domperidone were studied in 75 regularly menstruating women and 44 patients with moderate hyperprolactinemia. It was found that, for the entire sample, the responses to each of the stimuli could be described by a continuous function of the basal PRL levels. The present work provides evidence for the following conclusions: 1) The PRL responses to thyrotropin-releasing hormone and to domperidone merely bring additional diagnostic information relative to basal PRL levels in the occasional patients with macroprolactinemia; 2) there is a continuous spectrum of lactotroph activities in women, ranging from normal secretors through an intermediate group of hypersecretors (with progressively increased serum PRL levels and decreased responsiveness to stimuli) to full-blown prolactinomas; and 3) idiopathic hyperprolactinemia is a heterogeneous entity that includes the above intermediate group of patients, women with macroprolactinemia, and patients with undiagnosed prolactinomas.

Psychosomatic factors in patients with hyperprolactinemia and/or galactorrhea

A biographic and clinical investigation of 101 patients with hyperprolactinemia and/or galactorrhea is reported. Fifty-one patients were reared without their fathers and 18 with an alcoholic, violent one. These situations were uncommon in the control population, and the differences were statistically significant. There was a high frequency of complaints of obesity, headaches, frigidity, lightheadedness, and fullness of the abdomen, limbs, or face. There was a significant temporal correlation of external events in the natural history with onset or worsening of the symptoms. It is concluded that exposure during childhood to an environment characterized by an absent or alcoholic, violent father conditions some women to develop hyperprolactinemia and/or galactorrhea later in life as a response to specific environmental changes. These conclusions apply similarly to patients with prolactinoma, idiopathic hyperprolactinemia, and euprolactinemic galactorrhea, suggesting a close relationship among the 3 entities.