Browsing by Author "Fonseca, C."
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- Dynamic functional connectivity in migraine during the interictal phase: a resting-state fMRI studyPublication . Esteves, I.; Fonseca, C.; Xavier, M.; Fouto, A.; Ruiz-Tagle, A.; Caetano, G.; Nunes, R.; Gil-Gouveia, R.; Cabral, J.; Martins, I. Pavão; Rosa, A; Figueiredo, P.Question: Migraine is a cyclic and complex disorder, characterized by attacks of headache, sensory and cognitive disturbances1. Thalamocortical connectivity in migraine has been found to be transiently abnormal2. Our aim was to assess if the dynamical properties of the migraine brain are affected during the interictal phase. Methods: Resting-state functional MRI data was collected from 14 menstrual migraine patients without aura (interictal phase) and 12 healthy controls (menstrual post-ovulation phase). fMRI data processing included3: motion and distortion correction, temporal highpass filter, regression of motion and physiological confounds, spatial smoothing, and parcellation with the Desikan atlas. Dynamic functional connectivity (dFC) between regions was computed using phase coherence, and recurrent dFC states were identified by kmeans clustering (k ranging between 3 and 15) of the leading eigenvectors of dFC in each time point4. Permutation tests were performed to evaluate statistically significant differences between patients and controls in the probability of occurrence and the mean lifetime of the dFC states. Results: Similar dFC states were found consistently across different numbers of clusters, k, which resembled the canonical resting-state networks as expected. Compared to healthy controls, migraine patients show a significantly lower mean lifetime in one dFC state, when grouping in 4, 5 and 6 clusters. No differences were found for the probability of occurrence. Conclusions: Migraine may be linked to a disruption of brain networks dynamics. This emphasizes the need to adopt time-resolved methods, in addition to static, to study functional connectivity, to better understand the mechanisms of migraine. Our next step will be to assess the dynamics of the migraine brain throughout the migraine cycle.
- The disease burden of heart failure in PortugalPublication . Jesus, G.; Fiorentino, R.; Ascenção, R.; Gouveia, M.; Costa, J.; Broeiro, P.; Fonseca, C.; Borges, M.Objectives: The objective of this study is to estimate the disease burden of Heart Failure (HF) in Portugal for 2014.MethOds: The HF burden was measured in Disability Adjusted Life Years (DALY) resulting from the sum of Years Lost due to Disability (YLD) and Years of Life Lost (YLL) due to premature death. YLL were esti-mated based on the mortality rates reported by the European Detailed Mortality Database. For YLD, the three disability weights (mild moderate and severe) presented by the Global Burden of Disease Study (2015) were considered. Patients in the first class of the New York Heart Association (NYHA) Functional Classification, where considered to have no disability associated to HF. The average total disease duration by age group and the overall incidence were estimated using the software DisMod II, calibrated with the prevalence of NYHA class II-IV, relative risk of mortality and a remission rate of zero. Prevalence was estimated using the microdata of a previously conducted national community-based epidemiological survey while relative risk of mortality came from the international literature. It was assumed that incidence by severity class followed the same pattern as prevalence and that duration was independent from severity.Results: In 2014, HF incident cases in NYHA class II-IV were estimated to be 38,960 (394.74/100,000 inhabitants). The deaths for HF patients amounted to 4,688, 4.7% of overall deaths, with women being responsible for 66.7% of HF mortality. Overall, DALY totaled 21,162, with 53.8% due to YLL and 46.2% due to YLD. Women contributed to most of the overall disease burden in terms of DALY (57.0%) with YLL and YLD estimated at 6.944 and 5.118, respectively.cOnclusiOns:Heart Failure is an important cause of disease burden in Portugal. Heart Failure should be an important target for health policy interventions.
- The impact of ageing on the future costs and burden of heart failure in PortugalPublication . Gouveia, M.; Ascenção, R.; Fiorentino, F.; Costa, J.; Broeiro, P.; Fonseca, C.; Borges, M.Objectives: To estimate, the impact of population ageing on the costs and burden of Heart Failure (HF) in Portugal over a twenty-year horizon, between 2014 and 2034. MethOds: HF costs were estimated using a prevalence-based approach. Costs and disability were assumed zero for patients in class I of the New York Heart Association (NYHA) Functional Classification. The prevalence rate was estimated using microdata from a previous epidemiological survey. Average direct costs per patient were estimated using: 1) a primary care national database with records of 25,337 patients registered with HF; 2) National DRG microdata; 3) expert panel; 4) national literature, reports and legislation. Indirect costs associated to patients’ absenteeism and early exit from the labour force were considered. The burden was measured in Disability Adjusted Life Years (DALY) resulting from the sum of Years Lost due to Disability (YLD) and Years of Life Lost (YLL) due to premature death. For YLL, mortality rates reported in the European Detailed Mortality Database were considered. For YLD, disease duration and the overall incidence were estimated using the software DisMod II. Disability weights were retrieved from published literature. Population ageing was carried out by a shift-share analysis using the official demographic projections. Results: Considering only population ageing on a 20-year horizon, HF prevalence (class II-IV) is expected to increase by 25%, reaching over 312,000 patients in 2034. Total costs in 2014 and 2034 are estimated, respectively, at €289M and €364M (at today’s prices), with an increase in the costs per inhabitant of 34%. In 2034, total DALY are expected to be 25% higher than in 2014, from 21,162 to 26,521. The contribution of YLL will increase from 54% to 61%. cOnclusiOns: Population ageing will substantially increase the burden of HF in Portugal. Health policy makers should consider new strategies to deal with this problem.