Ana Rute Costa

Impact of breast cancer treatments on sleep disturbances - A systematic review

Sleep disturbances are highly prevalent in women with breast cancer; side effects of cancer treatment may worsen pre-existing sleep problems and have been pointed to as important determinants of their incidence. Therefore, we aimed to assess the association between different types of breast cancer treatment and sleep disturbances, through a systematic review. Medline (using PubMed), CINAHL Plus with full text, PsycINFO and Cochrane Central Register of Controlled Trials (Central) were searched from inception to January 2014. Studies that evaluated samples of women with breast cancer, assessed sleep disturbances with standardized sleep-specific measures, and provided data for different cancer treatments were eligible. A total of 12 studies met the inclusion criteria. Three studies evaluated insomnia, five studies assessed sleep quality, two provide data on general sleep disturbances and two analysed specific sleep parameters. Women submitted to chemotherapy, or radiotherapy, tended to report higher levels of sleep disturbances. More heterogeneous findings were observed regarding the effect of surgical treatment and hormonal therapy. However, a sound assessment of the impact of these treatments was hampered by differences across studies regarding the outcomes assessed, reporting bias and the fact that most studies did not control for the effect of potential confounders. The present review highlights the potential relation between breast cancer treatments and sleep disturbances, particularly of chemotherapy, though more robust evidence is needed for a proper understanding of these associations.

Cancer screening in Portugal: sex differences in prevalence, awareness of organized programmes and perception of benefits and adverse effects

Cancer screening has contributed to downward trends in cancer mortality, but is also associated with adverse effects, which highlights the importance of promoting the participation based on informed decisions.

Singing in chronic obstructive pulmonary disease patients: A pilot study in Portugal

Chronic obstructive pulmonary disease (COPD) is a disorder characterized by airflow limitation that is not fully reversible. The severity and magnitude of the symptoms increase as the disease progresses, leading to significant disability and a negative effect on quality of life. Despite optimal treatment with pharmacological agents, classic pulmonary rehabilitation and oxygen, many patients continue to be symptomatic. It is well known that respiration is an essential factor for singing and that this technique involves strong fast inspirations, followed by extended, regulated expirations, which require accurate control of breathing. 1,2,4--6 The objective of this study was to investigate the effects of weekly singing classes on maximal respiratory pressures, spirometric measurements, parameters in sixminute walk test (6MWT), maximum expiration breathing time and health-related quality of life (QoL) in patients with COPD. Patients with COPD who were attending a maintenance pulmonary rehabilitation program (90 min, twice a week) at the Physical Medicine and Rehabilitation Department in Pedro Hispano Hospital were invited to participate in the study. They had to have been diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). All subjects had to have been in a stable clinical condition for at least 6 weeks before admission to the study and to have signed a written informed consent at their initial visit. Demographics, height, weight and clinical history were recorded. All patients initially completed plethysmography (FVC, FEV1, FEV1/FVC, TLC and RV); maximal inspiratory and expiratory pressures at the mouth level (MIP, MEP); assessment of QoL employing Saint George’s Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and EuroQoL Test; Hospital Anxiety and Depression Scale (HADS); London Chest Activity of Daily Living Scale (LCADL) and Medical Research Council Dyspnoea Questionnaire (mMRC) for dyspnea; six minutes walk test (6MWT) with documentation of time taken to recover oxygen saturation, Modified Borg dyspnea score and heart rate following the test. Maximum expiration breathing time was always assessed by the same researcher. The patients were enrolled in weekly classes lasting approximately 1 h, for 10 weeks. The classes were coordinated by a singing teacher and a physiotherapist. The patients participated in the classes as a group and the activities included the following:

Health-related knowledge of primary prevention of cancer in Portugal.

The increasing number of new cases of cancer highlights the relevance of primary prevention for cancer control, which is influenced, among other factors, by the population’s health-related knowledge. Therefore, we aimed to describe cancer-related knowledge in Portugal, including perception of risk, awareness of cancer causes and preventive behaviours. We evaluated 1624 Portuguese-speaking dwellers, aged between 16 and 79 years, through face-to-face interviews conducted using a structured questionnaire. We computed adjusted (sex, age, education) regression coefficients and prevalence ratios, using linear and Poisson regression, respectively, to quantify associations with cancer-specific knowledge. The proportions of nonresponse ranged from 13.4 to 63.5% for the most frequent cancer in Portugal and the leading cause of cancer, respectively. The mean of the estimated lifetime risk of cancer in the Portuguese population was 37.0%. A total of 47.5% of the respondents identified breast cancer as the most frequent in Portugal, 72.0% named lifestyles as the leading cause of cancer and 40.2% selected not smoking as the most important preventive behaviour. Lower levels of education were associated with higher proportions of nonresponse, but not consistently with inaccurate knowledge. Men provided lower estimates of the lifetime risk of cancer, indicated breast cancer less frequently and more often lung cancer as the most frequent, and were more likely to select not smoking as the most important preventive behaviour. The present study provides relevant data on knowledge of cancer prevention, which may be used for the planning and evaluation of awareness-raising and primary prevention interventions in Portugal.

Contemporary migration patterns in the prevalence of Helicobacter pylori infection: A systematic review

A rapid growth in the number of international migrants over the past years has occurred with most traveling to more affluent settings. As Helicobacter pylori infects over half of the adult population and its prevalence is higher in developing countries, understanding the prevalence of infection in migrants can provide insight into future trends in the burden and management of infection. We aimed to describe the prevalence of H. pylori among migrants through a systematic literature review.

Protein Electrophoresis in Saliva Study

Saliva started for been less studied than other body fluids, but in the last years it has being receiving an increased attention. Until now, more than 2000 different proteins and peptides have been identified in whole saliva and salivary glandular secretions [1]. From these, more than 90% derive from the secretion of the three pairs of “major” salivary glands (parotid, submandibular and sublingual glands). The remaining 10% derives from “minor” salivary glands and from extra-glandular sources, namely gingival crevicular fluid, mucosal transudations, bacteria and bacterial products, viruses and fungi, desquamated epithelial cells, and food debris [2].

The occupational risk of Helicobacter pylori infection: a systematic review

PurposeThe aim of this systematic review was to describe the prevalence of Helicobacter pylori infection in specific occupational groups and to compare them with the general population.MethodsWe searched PubMed® to identify original studies reporting the prevalence of H. pylori infection in occupational groups. The differences between occupational groups and the general population were analyzed taking into account the direction and statistical significance of the differences observed when comparing each occupational group with a reference group (either recruited in the same study or using an external comparator).ResultsA total of 98 studies addressing the prevalence of H. pylori infection in occupational groups were included in the systematic review. Overall, health professionals showed a significantly higher prevalence of H. pylori infection than the general population, especially among those working at gastrointestinal units. Similar results were found in subjects involved in agricultural, forestry and fishery, as well as in sewage workers, miners, and workers at institutions for the intellectually disabled, although differences were less pronounced.ConclusionsOur results show an occupational risk of H. pylori infection supporting the role of oral–oral, fecal–oral, and zoonotic transmission. Studies comparing specific occupational groups with adequate comparators may contribute to better identify groups at higher risk of infection. The recognition of this infection as an occupational disease would result in early detection and treatment, as well as prevention and control of its transmission in workplaces.

Projections in Breast and Lung Cancer Mortality among Women: A Bayesian Analysis of 52 Countries Worldwide

Among women, lung cancer mortality rates have surpassed those for breast cancer in several countries. This reflects the breast cancer mortality declines due to access to screening and effective treatment alongside the entrance of certain countries in stages of the tobacco epidemic in which smoking becomes more prevalent in women. In this study, we project lung and breast cancer mortality until 2030 in 52 countries. Cancer mortality data were obtained from the WHO Mortality Database. Age-standardized mortality rates (ASMR), per 100,000, were calculated (direct method) for 2008 to 2014 and projected for the years 2015, 2020, 2025, and 2030 using a Bayesian log-linear Poisson model. In 52 countries studied around the world, between 2015 and 2030, the median ASMR are projected to increase for lung cancer, from 11.2 to 16.0, whereas declines are expected for breast cancer, from 16.1 to 14.7. In the same period, the ASMR will decrease in 36 countries for breast cancer and in 15 countries for lung cancer. In half of the countries analyzed, and in nearly three quarters of those classified as high-income countries, the ASMR for lung cancer has already surpassed or will surpass the breast cancer ASMR before 2030. The mortality for lung and breast cancer is higher in high-income countries than in middle-income countries; lung cancer mortality is lower in the latter because the tobacco epidemic is not yet widespread. Due to these observed characteristics of lung cancer, primary prevention should still be a key factor to decrease lung cancer mortality.Significance: The mortality for lung and breast cancer is projected to be higher in high-income countries than in middle-income countries, where lung cancer mortality is expected to surpass breast cancer mortality before 2030. Cancer Res; 78(15); 4436-42. ©2018 AACR.

Health-related knowledge on hypertension among the Portuguese population: results from a population-based survey

Abstract Purpose: Adequate knowledge on hypertension has been shown to improve awareness, adherence to treatment and control of the disease. We aimed to estimate the health-related knowledge about hypertension among the Portuguese population. Materials and methods: A representative sample of Portuguese-speaking dwellers in mainland Portugal (n = 1624), aged 16 to 79 years, was evaluated through face-to-face interviews conducted using a structured questionnaire. Health literacy was evaluated using the instrument Newest Vital Sign. Results: The mean prevalence of hypertension in the Portuguese population estimated by the participants in this study was 45.4%. Salt intake and poor diet were reported as main causes of hypertension by 27.5% and 21.5% of the participants, respectively, whereas more than 85% acknowledged myocardial infarction and stroke as its main consequences. However, 31.2% of the participants were not able to identify a cause for high blood pressure, especially the older and those with worse scores for health literacy. The accurate interpretation of blood pressure values diminished with the increase of systolic and diastolic blood pressure figures provided as examples for interpretation, from approximately 80% for 95/60 mmHg to 50% for 180/100 mmHg. Women and participants with greater levels of education or a previous diagnosis of hypertension tended to interpret blood pressure values correctly more often. Conclusions: This study provided a quantitative estimate of the gaps in health-related knowledge about hypertension among the general population. Understanding the barriers that hinder the achievement of health-related knowledge on hypertension is expected to contribute for the global improvement of prevention and management of hypertension.

Cancer-related knowledge and health status among cancer survivors in Portugal

In the last few years, a striking increase in the number of cancer survivors (CS) has been observed, mainly due to the increment in the number of new cases of cancer being diagnosed and the use of more effective treatments. This fact brings new challenges for health services, since CS often experience late and long-term adverse effects of cancer and its treatments,1 including second primary cancers, cardiovascular complications, depression, pain or fatigue, which may contribute for a poorer perceived health status and a greater use of health care.2 In addition, a life event such as cancer can be a teachable moment, providing many opportunities to improve health knowledge and behaviours. However, the information needs of CS are mainly treatment-related, with a marginal interest in surveillance and health information,3 which can hamper the adoption of healthier behaviours, although CS are, in general, more likely to seek cancer information than individuals without this disease (NC).4 In this context, we compared CS and NC regarding cancerrelated knowledge, health status, health care use and lifestyles. We selected CS and sex-, ageand education-matched (1:4) NC, among participants of a national population-based cross-sectional study.5 A total of 39 CS, corresponding to a prevalence of 1.4%, and 156 NC were included in this study. Data was collected through face-toface interviews, using a structured questionnaire, and the effect of a previous diagnosis of cancer was quantified through prevalence ratios (PR), and respective 95% confidence intervals (95% CI). Figure 1 depicts the perception of potential consequences of cancer, health status and health care use among CS and NC. Except for “impaired working capacity”, CS tended to identify more often all health problems as potential consequences of cancer, with significant differences for “cancer recurrence” (PR = 1.16; 95%CI: 1.04-1.28). They also reported a poorer health status (PR = 2.75; 95%CI:1.82-4.17) and greater prevalence of cardiovascular diseases (PR = 5.33; 95%CI:1.96-14.52), hypertension (PR = 1.95; 95%CI: 1.28-2.97), depression (PR = 3.67; 95%CI: 1.75-7.69) and anxiety (PR = 5.14; 95%CI: 2.81-9.42). Consumption of medication (PR = 1.14, 95%CI: 1.01-1.28), annual screening for breast (PR = 2.93; 95%CI: 1.92-4.46), cervix (PR = 2.02; 95%CI: 1.22-3.34) and prostate cancers (PR = 3.12; 95%CI: 1.36-7.16) were more frequent among CS. Regarding the most important behaviour for cancer prevention, CS tended to refer more frequently “regular check-ups”, “healthy diet” and “not drinking”, and less often “not smoking” and “blood analysis”, albeit these associations were not statistically significant. Additionally, no statistically significant differences were observed between CS and NC regarding smoking, alcohol intake, consumption of fruits and/or vegetables, and physical activity. In conclusion, this exploratory investigation has shown that, among CS, there is margin for improvement of knowledge about oncological diseases, and health promotion interventions targeting this specific population are needed. It also confirmed a worse health status, and a higher use of health care resources among CS, particularly concerning the consumption of medication and cancer screening. Hence, the present work provides a benchmark to design and evaluate the effectiveness of knowledge-raising activities targeting CS, to understand the burden of cancer survivorship, and to allocate appropriate resources for national cancer survivorship care plans.