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Vaz-Pinto I, Ortega E, Chivite I, Butí M, Turnes-Vázquez J, Magno-Pereira V, Rocha M, Garrido J, Esteves-Santos C, Guimaraes M, Mourão T, Martínez Roma M, Guilera V, Llaneras-Artigues J, Barreira-Díaz A, Pérez Cachafeiro S, Daponte Angueira S, Xavier E, Vicente M, Garrido G, Heredia MT, Medina D, García Deltoro M. Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention. Front Public Health 2024; 11:1268888. [PMID: 38328544 PMCID: PMC10847218 DOI: 10.3389/fpubh.2023.1268888] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Background Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. Methods The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. Intervention BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Results Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Conclusions Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.
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Affiliation(s)
- Inês Vaz-Pinto
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Enrique Ortega
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
| | - Ivan Chivite
- Unidad de Enfermedades Infecciosas, Hospital Clínic i Provincial de Barcelona (HClinic), Barcelona, Spain
| | - María Butí
- Servicio de Hepatología, Hospital Universitari Vall d'Hebron (HVHEBRON), Barcelona, Spain
- CIBER Enfermedades Hepáticas y Digestivas del Instituto Carlos III, Madrid, Spain
| | | | - Vítor Magno-Pereira
- Serviço de Saúde da Região Autónoma da Madeira (SMADEIRA), Madeira, Portugal
- Universidade da Madeira, Madeira, Portugal
| | - Miguel Rocha
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | | | - Catarina Esteves-Santos
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Mafalda Guimaraes
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Tomás Mourão
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - María Martínez Roma
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
| | - Vanessa Guilera
- Unidad de Enfermedades Infecciosas, Hospital Clínic i Provincial de Barcelona (HClinic), Barcelona, Spain
| | | | - Ana Barreira-Díaz
- Servicio de Hepatología, Hospital Universitari Vall d'Hebron (HVHEBRON), Barcelona, Spain
| | | | | | - Elisa Xavier
- Serviço de Saúde da Região Autónoma da Madeira (SMADEIRA), Madeira, Portugal
| | | | | | | | - Diogo Medina
- Gilead Sciences, Madrid and Lisbon, Spain and Portugal
| | - Miguel García Deltoro
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
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Buti M, Vaz-Pinto I, Magno Pereira V, Casado M, Llaneras J, Barreira A, Esteves C, Guimarães M, Gorgulho A, Mourão T, Xavier E, Jasmins L, Reis AP, Faria N, Freitas B, Andrade G, Camelo-Castillo A, Rodríguez-Maresca MÁ, Carrodeguas A, Medina D, Esteban R. Emergency department contribution to HCV elimination in the Iberian Peninsula. Int J Emerg Med 2024; 17:5. [PMID: 38178000 PMCID: PMC10768527 DOI: 10.1186/s12245-023-00570-5] [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: 11/04/2022] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Undiagnosed cases of hepatitis C virus (HCV) infection result in significant morbidity and mortality, further transmission, and increased public health costs. Testing in emergency departments (EDs) is an opportunity to expand HCV screening. The goal of this project was to increase the proportion of eligible patients screened for HCV in urban areas. METHODS An opportunistic automated HCV screening program was implemented in the EDs of 4 public hospitals in Spain and Portugal at different periods between 2018 and 2023. HCV prevalence was prospectively evaluated, and single-step or reflex testing was used for confirmation in the same sample. RESULTS More than 90% of the population eligible for testing were screened in the participating centers. We found HCV antibody seroprevalence rates ranging from 0.6 to 3.9%, with between 19 and 53% of viremic individuals. CONCLUSIONS Opportunistic HCV screening in EDs is feasible, does not disrupt ED activities, is highly effective in increasing diagnosis, and contributes to WHO's HCV elimination goals.
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Affiliation(s)
- Maria Buti
- Hospital Universitari Vall d'Hebron and CIBEREHD del Instituto Carlos III, 119, 08035, Barcelona, Spain.
| | | | | | - Marta Casado
- Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - Ana Barreira
- Hospital Universitari Vall d'Hebron and CIBEREHD del Instituto Carlos III, 119, 08035, Barcelona, Spain
| | | | | | | | | | | | | | | | - Nancy Faria
- Hospital Dr. Nélio Mendonça, Madeira, Portugal
| | | | | | | | | | | | | | - Rafael Esteban
- Hospital Universitari Vall d'Hebron and CIBEREHD del Instituto Carlos III, 119, 08035, Barcelona, Spain
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Zorrilla R, Poltosi M, Gadelha L, Porto F, Moura A, Dalto A, Lavrado HP, Valentin Y, Tenório M, Xavier E. Conceptual View Representation of the Brazilian Information System on Antarctic Environmental Research. Data Sci J 2014. [DOI: 10.2481/dsj.ifpda-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Werkhäuser RP, De Simone SG, Xavier E, Montenegro SM, Abath FG. Mapping of the N terminus of the Schistosoma mansoni tegumental antigen Sm15 to its predicted precursor protein. Int J Parasitol 2000; 30:859-61. [PMID: 10899532 DOI: 10.1016/s0020-7519(00)00069-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sm15 is a major Schistosoma mansoni 15 kDa tegumental antigen, resulting from the proteolytic processing of a larger precursor. The amino terminus of Sm15 was identified by direct amino acid sequencing, and the antigen was tentatively mapped to the segment spanning amino acids 362-497 of the precursor. This will allow subsequent studies to elucidate the possible immunological role of proteolytic processing in schistosomiasis.
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Affiliation(s)
- R P Werkhäuser
- Departamento de Imunologia, Cidade Universitária, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Av. Moraes Rego s/n, 50670-420, PE, Recife, Brazil
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Lemos C, Santos P, Xavier E, Vicente T, Mesquita J, Loureiro F, Ochoa A. [Congenital cyst adenomatoid malformation of the lung]. ACTA MEDICA PORT 1998; 11:697-701. [PMID: 9859519] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The authors report two cases of Congenital Cyst Adenomatoid Malformation diagnosed by ultrasound in the 24th and 27th weeks of pregnancy. The pregnancies had no other problems until their term and deliveries were normal. Surgical resection of the malformation was made on the 8th day of life in one child and on the 11th day in the other. After 2 years, the first child shows a good evolution in weight and height, without lung pathology. After 2 months, the other child also shows a similar condition.
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Affiliation(s)
- C Lemos
- Maternidade Bissaya-Barreto, Hospital Pediátrico de Coimbra
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Mota C, Henriques C, Sarmento M, Pereira E, Xavier E, Pereira M. Kidney transplantation in pediatric population. Transplant Proc 1994; 26:2768-70. [PMID: 7940872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- C Mota
- Department of Pediatric Nephrology H.M. Pia, Oporto, Portugal
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Torres S, Maximino J, Pereira S, Oliveira A, Henriques C, Sarmento M, Gomes L, Xavier E, Pimenta A. [Morphologic course of the left ventricle after renal transplantation. Echocardiographic study]. Rev Port Cardiol 1991; 10:497-501. [PMID: 1931109] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To characterize and to quantitate the morphologic changes in left ventricle, in renal transplant patients (Pts) treated with cyclosporine, through sequential echocardiographic examinations. DESIGN A prospective study of renal transplant patients, between October/88 and May/89, who maintained good function of the renal graft during the follow-up. SETTING Cardiology and Nephrology departments of Santo António Hospital. MATERIAL AND METHODS 20 patients, 13 men and 7 women, mean age of 33 +/- 10, ranging from 20 to 56, constitute the final group of the study. These patients have been receiving dialysis during 3.8 +/- 2.3 years (0.4-8). Seven patients were excluded, five by echocardiographic criteria and another two because of chronic renal graft disfunction (creatinine greater than 2.0 mg%). The echocardiographic examinations were performed during the first week, and 1, 2, 3, 6 and 12 months after renal transplantation. The following measurements were performed: left ventricular end-diastole diameter (LVED), interventricular septal thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI). The measurements were obtained in M-mode following the conventional recommendations. Average values of at least 3 cardiac cycles were used. Heart rate, blood pressure, creatinine, hematocrit, body surface area and fistula patency, were determined at the time of each echocardiogram. MAIN RESULTS The LVED decreased progressively until the third month, from 51.9 +/- 7 mm to 47.8 +/- 6 mm (p less than 0.001), remaining stable thereafter. The baseline value of IVST, 13.6 +/- 5 mm, was similar at the twelfth month, 13.8 +/- 2 mm (ns). The baseline value of PWT, 13.7 +/- 4 mm, decreased gradually since the second month, having reached 12.7 +/- 2 mm at the twelfth month (ns). The LVMI (g/m2) reduced progressively, from 243 +/- 82 to 190 +/- 38 at the end of the study (p less than 0.05. A high incidence of arterial hypertension was detected during the follow-up period; at the twelfth month, 18 patients (90%) were on antihypertensive drug therapy, 11 of which had blood pressure greater than or equal to 160/95 mmHg. CONCLUSIONS We verified, one year after the renal transplantation, a significant decrease of LVMI, that was mainly determined by the LVED reduction. Left ventricular walls thickness had no significant variation; we think that the high incidence of hypertension during the follow-up period, in part due to the pressure effect of cyclosporine, may have been responsible for this fact.
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Affiliation(s)
- S Torres
- Serviço de Cardiologia do Hospital Geral de Santo António, Porto
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