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Background: One of the risk factors for suicide includes the presence of depressive disorder and symptoms, which may be related to the reduction of 25-hydroxyvitamin D serum levels. In this scenario, evidence shows vitamin D deficiency as an important aspect directly related to depressive disorder chronicity. Objective: To assess the association between Vitamin D serum levels and the intensity of depressive symptoms and suicidal behavior in a clinical sample of depressed patients. Methods: A cross-sectional study with 146 patients aged between 18 and 59, seen in two psychiatry ambulatories. Data collection involved measurement of serum 25-hydroxyvitamin D levels and assessment of the intensity of depressive symptoms and suicide risk. Results: In the sample, 35% presented low Vitamin D serum levels and, in these individuals, the incidence of family history of Depressive Disorder (95.2%) and chronicity of severe depressive symptoms (47.8%) was higher. As to suicidal behavior, both groups presented high active suicide risk, with higher rates in the group with hypovitaminosis D. Only suicidal ideation was linked to lower Vitamin D levels (67.4% p= 0,005). Conclusion: In this study, hypovitaminosis D was associated with negative mental health outcomes, such as more severe chronicity of depressive symptoms and suicidal behavior, characterized by active suicidal ideation.

Epidemiological studies on the impact of determining environmental factors on human health have proved that temperature extremes and variability constitute mortality risk factors. However, few studies focus specifically on susceptible individuals living in Portuguese urban areas. This study aimed to estimate and assess the health burden of temperature-attributable mortality among age groups (0–64 years; 65–74 years; 75–84 years; and 85+ years) in Lisbon Metropolitan Area, from 1986–2015. Non-linear and delayed exposure–lag–response relationships between temperature and mortality were fitted with a distributed lag non-linear model (DLNM). In general, the adverse effects of cold and hot temperatures on mortality were greater in the older age groups, presenting a higher risk during the winter season. We found that, for all ages, 10.7% (95% CI: 9.3–12.1%) deaths were attributed to cold temperatures in the winter, and mostly due to moderately cold temperatures, 7.0% (95% CI: 6.2–7.8%), against extremely cold temperatures, 1.4% (95% CI: 0.9–1.8%). When stratified by age, people aged 85+ years were more burdened by cold temperatures (13.8%, 95% CI: 11.5–16.0%). However, for all ages, 5.6% of deaths (95% CI: 2.7–8.4%) can be attributed to hot temperatures. It was observed that the proportion of deaths attributed to exposure to extreme heat is higher than moderate heat. As with cold temperatures, people aged 85+ years are the most vulnerable age group to heat, 8.4% (95% CI: 3.9%, 2.7%), and mostly due to extreme heat, 1.3% (95% CI: 0.8–1.8%). These results provide new evidence on the health burdens associated with alert thresholds, and they can be used in early warning systems and adaptation plans. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00536-z.

The present work evaluated the surveillance of the drinking water quality information system database and correlated the findings of the microbiological analysis with the distribution of intestinal protozoa from the metropolitan region of Rio de Janeiro. From the database, we obtained 1,654 georeferenced monitoring stations that were used in the analysis. The results indicate that the minimum number of samples collected per parameter (free residual chlorine, turbidity, counts of total and fecal coliforms (Escherichia coli)) was not fulfilled, the collection of samples throughout the year was irregular and the representability of sampling points considered strategic was low (48% of municipalities). Besides, municipalities with a high prevalence for intestinal parasite protozoa were also the ones that had the highest counts for coliforms and the reverse can also be observed, indicating a transmission through contaminated drinking water. Despite the increased participation of municipalities in water surveillance actions during the studied period, it is necessary to implement managerial measures to improve the system, aiming to correct flaws and inconsistencies in the application of the water quality monitoring protocol. HIGHLIGHTS Analysis of the water surveillance protocol of Rio de Janeiro metropolitan area.; First report to evaluate the surveillance of the drinking water quality information system database of RJ (Brazil).; Possible transmission route of intestinal parasitic infections through drinking water contamination.; Noncompliance with drinking water legislation.; Need for urgent improvement in the drinking water surveillance program.

A Profilaxia Pre-exposicao de risco a infeccao pelo virus do HIV (PrEP) tem sido considerada uma estrategia com grande eficacia na prevencao do HIV. Segundo dados do Ministerio da Saude, a PrEP comecou a ser oferecida pelo SUS no final de 2017, de forma gradual no Brasil. Objetivou-se nesta pesquisa analisar o perfil de atendimentos dos usuarios da profilaxia pre-exposicao de risco a infeccao pelo HIV (PrEP) em um servico de referencia no interior de Minas Gerais. Trata-se de um estudo descritivo, retrospectivo, com abordagem quantitativa. A coleta de dados foi realizada no ano de 2020, por meio de dados secundarios obtidos pela Coordenacao Estadual de IST, Aids e Hepatites Virais de Minas Gerais. Foram analisados 68 prontuarios de usuarios cadastrados no programa da PrEP nos anos de 2018 a 2019 de um municipio do interior de Minas Gerais. A populacao analisada foi constituida em sua maioria por adultos e jovens que se somam 83,28% com idade entre 18 a 49 anos, sendo que a orientacao sexual, houve maior percentual de heterossexuais, seguido por homossexual/gay e uma minoria para bissexuais, demonstrando que e um desafio fazer com que a profilaxia chegue a quem mais pode se beneficiar dela e esteja em maior risco de contrair o HIV. Com isso, concluiu-se que foi possivel identificar o perfil e as barreiras de acesso ao servico de saude, principalmente as relacionadas ao estigma e a discriminacao, que impedem que as populacoes eleitas ao uso da PrEP possam se beneficiar e acessar essas tecnologias.

Introdução: A telessaúde é uma das estratégias de qualificação da atenção primária. Não há trabalho que analise sua utilização no Programa Mais Médicos. Logo, buscou-se analisar a utilização das ferramentas de telessaúde no Mais Médicos do estado do Espírito Santo, em 2016. Objetivo: Analisar a utilização das ferramentas de telessaúde no Mais Médicos do estado do Espírito Santo em 2016. Métodos: Trata-se de um estudo transversal, com aplicação de questionário estruturado ao total de médicos presente em seminários regionais em telessaúde. A análise incluiu frequência absoluta e relativa e análise bivariada com teste exato de Fisher. Resultados: Como resultado, 211 médicos (48,6% do total de profissionais do Mais Médicos) participaram, na maioria cubanos que atuavam em grande centro urbano com especialização em Medicina de Família e Comunidade. A maior parte (n=130, 61,9%) já havia utilizado algum serviço de telessaúde, mas de forma descontínua, sendo a teleducação o mais utilizado (n=101; 77,7%). Conhecer o Programa Telessaúde Brasil Redes e suas ferramentas e vê-las como relevantes para a melhoria do serviço associou-se a maior uso das tecnologias. A facilidade e o tipo de dispositivo utilizado para acessar a internet não influenciam a utilização do programa. Conclusões: Conclui-se que o conhecimento das ferramentas de telessaúde e a relevância dada a elas pelos profissionais e seu entorno estão mais associados a seu uso que as condições estruturais de trabalho.

OBJECTIVES: Since there are difficulties in establishing effective treatments for COVID-19, a vital way to reduce mortality is an early intervention to prevent disease progression. This study aimed to evaluate the performance of patients with COVID-19 with acute hypoxic respiratory failure according to pulmonary impairment in the awake-prone position, outside of the intensive care unit (ICU). METHODS: A prospective observational cohort study was conducted on COVID-19 patients under noninvasive respiratory support. Clinical and laboratory data were obtained for each patient before the treatment and after they were placed in the awake-prone position. To identify responders and non-responders after the first prone maneuver, receiver operating characteristic curves with sensitivity and specificity of the PaO2/FiO2 and SpO2/FiO2 indices were analyzed. The maneuver was considered positive if the patient did not require endotracheal intubation for ventilatory assistance. RESULTS: Forty-eight patients were included, and 64.6% were categorized as responders. The SpO2/FiO2 index was effective for predicting endotracheal intubation in COVID-19 patients regardless of lung parenchymal damage (area under the curve 0.84, cutoff point 165, sensitivity 85%, specificity 75%). Responders had better outcomes with lower hospital mortality (hazard ratio [HR]=0.107, 95% confidence interval [CI]: 0.012-0.93) and a shorter length of stay (median difference 6 days, HR=0.30, 95% CI: 0.13-0.66) after adjusting for age, body mass index, sex, and comorbidities. CONCLUSIONS: The awake-prone position for COVID-19 patients outside the ICU can improve oxygenation and clinical outcomes regardless of the extent of pulmonary impairment. Furthermore, the SpO2/FiO2 index discriminates responders from non-responders to the prone maneuver predicting endotracheal intubation with a cutoff under or below 165.

Introduction: There is evidence that aldosterone plays a role in the pathogenesis of vascular calcification. The aim of this study was to evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, on the progression of coronary calcification (CC) in peritoneal dialysis patients and to identify the factors involved in this progression. Methods: Thirty-three patients with a coronary calcium score (CCS) ≥ 30, detected through multi-detector computed tomography (MDCT) and expressed in Agatston units, were randomly assigned to a group receiving 25mg spironolactone per day for 12 months (spironolactone group) and a control group not receiving this drug. The primary outcome was a percentage change in CCS from baseline to end of the study (relative progression), when a further MDCT was conducted. Patients who had progression of CC were compared with those who did not progress. Results: Sixteen patients, seven in the spironolactone group and nine in the control group, concluded the study. The relative progression of the CCS was similar in both groups, 17.2% and 27.5% in the spironolactone and control groups respectively. Fifty-seven percent of the treated patients and 67% of those in the control group presented progression in the CC scores (p = 0.697). Progressor patients differed from non-progressors because they presented higher levels of calcium and low-density lipoprotein cholesterol and lower levels of albumin. Conclusion: In peritoneal dialysis patients, spironolactone did not attenuate the progression of CC. However, large-scale studies are needed to confirm this observation. Disorders of mineral metabolism and dyslipidemia are involved in the progression of CC. RESUMO Introdução: Existem evidências de que a aldosterona exerça um papel na patogênese da calcificação vascular. O objetivo deste estudo foi avaliar o efeito da espironolactona, um antagonista do receptor mineralocorticoide, na progressão da calcificação coronariana (CC) de pacientes em diálise peritoneal, e identificar os fatores envolvidos nessa progressão. Métodos: Trinta e três pacientes com escore de cálcio coronariano (ECC) ≥ 30, detectado por tomografia computadorizada com múltiplos detectores (TCMD) e expresso em unidades de Agatston, foram randomizados para um grupo que recebeu 25 mg de espironolactona por dia durante 12 meses (grupo espironolactona) e um grupo controle que não recebeu este medicamento. O desfecho primário foi a mudança percentual do ECC do início para o final do estudo (progressão relativa), quando uma nova TCMD foi realizada. Os pacientes que tiveram progressão de CC foram comparados com aqueles que não progrediram. Resultados: Dezesseis pacientes, sete no grupo espironolactona e nove no grupo controle, concluíram o estudo. A progressão relativa do ECC foi semelhante nos dois grupos, 17,2% e 27,5% nos grupos espironolactona e controle, respectivamente. Cinquenta e sete por cento dos pacientes tratados e 67% daqueles no grupo controle apresentaram progressão nos escores de CC (p = 0,697). Os pacientes progressores diferiram dos não progressores porque apresentaram níveis séricos mais elevados de cálcio e LDL-colesterol e menores níveis de albumina. Conclusão: Em pacientes em diálise peritoneal, a espironolactona não atenuou a progressão da CC. No entanto, estudos em grande escala são necessários para confirmar essa observação. Distúrbios do metabolismo mineral e dislipidemia estão envolvidos na progressão da CC.

Background: Although the relationship between the occurrence of suicide and the presence of psychosocial suffering in bereaved relatives is clear, there are still few studies that deal with the detail of these repercussions and the therapeutic conduction given to them for the suicide. Objective: to carry out an integrative review on the psychopathological and psychosocial repercussions of suicide in the family, with emphasis on the detail of the main psychopathological characteristics presented by the individuals and the psychosocial impacts of mourning. Method: An integrative review was performed. The guiding question considered Population Intervention Comparator Outcome Setting and the revision protocol is in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The search occurred in the bases: Periodicals CAPES, PsycINFO and PubMed. Original articles were included, without language restriction that emphasized psychopathological and psychosocial aspects of the mourners after suicide. We excluded review studies, clinical cases, editorials and retrospectives. Results: The process of suicide mourning for family members is a complex event, marked by stigma and can predispose patients to mental illness and suicidal behavior, especially in the early years of mourning. In addition, it is necessary to expand the scope of evidence on the effectiveness of support and intervention with this population. Conclusion: Bereaved families need specialized preventive support insofar as the complexity of bereavement becomes a vulnerability factor for mental illness.

Pure component adsorption equilibrium of CH4 and CO2 on activated carbon have been studied at three different temperatures, 298, 323, and 348 K within a pressure range of 10–2000 kPa. Binar...

Large socioeconomic inequalities in health are still present in the Central Europe. The aim was to explore socioeconomic inequalities in mortality in Visegrad countries—the Czech Republic, Hungary, Poland and Slovakia (V4), by three different socioeconomic indicators (unemployment, risk of poverty/social exclusion, education). The study was conducted within the H2020 Euro-Healthy project. The associations between selected socioeconomic indicators and the standardised mortality rates by four main causes (mortality related to cancer, circulatory, respiratory and digestive system) in the economically active population aged 20–64 years in the 35 NUTS 2 level regions of the V4 in the period 2011–2013 were explored, using linear regression models. Lower education level was the most significant predictor of mortality in the V4. The lowest mortality rates by all causes of death were found in the regions of the Czech Republic, the highest in regions of Hungary. Despite the common origin, the pathways of the V4 countries in employment, poverty and education seem to be different, also having impact on health equity. Therefore, where you live in the V4 can significantly influence your health.

Background: The main objective was to study the seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women of Luanda (Angola), identify the primary maternal infection during gestation and to evaluate the socio-demographic risk factors associated with CMV and Rubella virus infections. Methods: A prospective cross-sectional study was conducted from August 2016 to May 2017. Blood samples were collected and specific anti-CMV and anti-Rubella antibodies (IgG and IgM) were quantified by electrochemiluminescence (COBAS e411). Demographic and clinical data were collected by standardized questionnaire. Bivariate and multivariate logistic regression analysis was used to quantify the effect of clinical and obstetric risk factors on virus seroprevalence. The level of statistical significance was set as pResults: The 396 pregnant women participated in the study aged from 15 to 47. Of the participants, 382 (96.5%) had anti-CMV IgG antibodies, 8 (2.0%) had anti-CMV IgG and IgM antibodies and 6 (1.5%) were seronegative. For Rubella virus, 347 (87.6%) were positive for anti-IgG, 4 (1.0%) positive for anti-IgG and IgM, and 45 (11.4%) were seronegative. The mean age of CMV positivity was 28.4 (SD ± 6.2) and for Rubella virus was 28.6 (SD ± 6.1). The multivariate logistic regression analysis has shown a significant association between Rubella virus infection and pregnant women without child (OR 2.673; CI: 1.026 - 7.007) and suffering spontaneous abortion (OR 3.232; CI: 1.192 - 7.952). In contrast, the level of schooling, residence, occupation, marital status, number of children in the household, basic sanitation, gestational age, history of miscarriages and hepatitis B were not significantly associated with the Rubella virus infection. Conclusions: Overall, this study showed that there is a high seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women in Luanda. Therefore, it is important a rapid and accurate diagnosis of CMV and Rubella infection in pregnant women to prevent congenital infections. Rubella vaccination should be offered to women non-immune to Rubella. Overall, it would be important to implement national screening for CMV, Rubella and other diseases linked to maternal and child health.

Altres ajuts: CEGOT, Foundation for Science and Technology UIDB/04084/2020 Altres ajuts: Fundação para a Ciência e a Tecnologia (SFRH/BD/132218/2017, UIDB/04084/2020) Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000-2003 and 2004-2008), and one after (2009-2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. Results: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. Conclusions: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.

Background: The world is experiencing one of the greatest public health emergencies in history with the global spread of COVID-19. Health systems, including Primary Health Care (PHC) services, are pillars of pandemic coping strategies. Objective: To systematic review of the literature that analyzes the effectiveness of PHC organization strategies in the context of epidemics. Methods: We performed a rapid systematic literature review on MEDLINE (via PubMed), EMBASE and LILACS (via VHL), in order to analyze empirical studies on the effectiveness of PHC organization strategies in the context of epidemics to improve access and reduce morbidity and mortality. There was no assessment of risk of bias, and the synthesis was narrative. PROSPERO CRD42020178310.Results: We selected seven articles, which studied the responses to different epidemic–s in different parts of the world. In terms of access, the studies suggest positive results with the adoption of adjustments of work processes of the teams and the structure of the services, combined with diversification of actions (including call center), adequate provision of inputs and personal protective equipment, adequate action plans and communication strategies, and effective integration with public health services and other levels of care. No study analyzed population morbidity and mortality. The included studies suggest also that community-oriented PHC is more effective in crisis scenarios, indicating the necessity of strengthening of the Family Health Strategy in the Brazilian context. Conclusion: PHC can be effective in coping with public health emergencies. Action plans should be built with broad participation by the actors involved in coping with the epidemic. Emphasis is placed on the importance of empowering the link between the healthcare service and its registered population.

Leptin is a hormone involved in the regulation of food intake, with receptors largely expressed centrally and peripherally, in structures like the hypothalamus and the liver. Beyond its well-known actions as an energy-balance regulator, leptin is linked to psychiatric disorders. Considering that the association between genetic and early environmental factors contributes to psychopathology, disruptions of leptin signaling could be a key mechanism in this interaction. To investigate this possibility, we created an expression-based polygenic risk score (ePRS) reflecting variations in the function of the LepR gene network in the liver and hypothalamus, and investigated its interaction with postnatal adversity on Child Behavior Checklist in 4 years old children (main cohort: MAVAN, N=137) and 17 years old teenagers (Replication Cohort: ALSPAC, N=2630). There is an interaction effect between adversity exposure and liver-based LepR-ePRS, increasing depressive and anxiety problems on the MAVAN cohort (β=78.16, p=0.02, β=83.77, p=0.01). In ALSPAC, the results were replicated, showing an interaction between adversity exposure and liver-based LepR-ePRS, increasing the depression score and somatic symptoms (β=24.65, p=0.005; β=33.51, p=0.009). No significant interactions were found using the hypothalamus-based LepR-ePRS (p>0.05), suggesting specificity for the liver LepR gene network to predict these behavioral outcomes. A parallel-independent component analysis showed relationships between the SNPs from the liver ePRS-LepR and gray matter density in cortical areas involved in emotion regulation (middle frontal gyrus, inferior parietal lobule and anterior cingulate). Finally, the relationship between gene and MRI components in this analysis is moderated by the history of early life adversity exposure. Enrichment analysis of the liver LepR co-expression network shows that these genes are related to biological processes including regulation of glucose transport, cholesterol metabolism and cellular glucose homeostasis, which indicates possible underlying mechanisms linking peripheral metabolism-related gene expression and the development of emotional symptoms. Our data supports the hypothesis that exposure to early adversity affects emotional behavior, and the liver LepR gene network is an important moderator of these effects. Further studies on development of emotional symptoms should consider metabolic markers to understand these complex phenotypes.

Background: Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Methods: Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. Results: The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced - (1) the 'Failing Europe' scenario (worst case/increasing inequalities), (2) the 'Sustainable Prosperity' scenario (best case/decreasing inequalities) and (3) the 'Being Stuck' scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. Conclusions: The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings. The EURO-HEALTHY project (Shaping EUROpean policies to promote HEALTH equity) has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 643398. Additionally, this study was supported by the Centre of Studies in Geography and Spatial Planning (CEGOT), funded by national funds through the Foundation for Science and Technology (FCT) under the reference UID/GEO/04084/2019. The authors Angela Freitas and Cláudia Costa are recipients of Individual Doctoral Fellowships funded by national funds through the Foundation for Science and Technology (FCT), under the references SFRH/BD/123091/2016 and SFRH/BD/132218/2017, respectively.

Variations in serotoninergic signaling have been related to behavioral outcomes. Alterations in the genome, such as DNA methylation and histone modifications, are affected by serotonin neurotransmission. The amygdala is an important brain region involved in emotional responses and impulsivity, which receives serotoninergic input. In addition, studies suggest that the serotonin transporter gene network may interact with the environment and influence the risk for psychiatric disorders. We propose to investigate whether/how interactions between the exposure to early life adversity and serotonin transporter gene network in the amygdala associate with behavioral disorders. We constructed a co-expression-based polygenic risk score (ePRS) reflecting variations in the function of the serotonin transporter gene network in the amygdala and investigated its interaction with postnatal adversity on attention problems in two independent cohorts from Canada and Singapore. We also described how interactions between ePRS-5-HTT and postnatal adversity exposure predict brain gray matter density and variation in DNA methylation across the genome. We observed that the expression-based polygenic risk score, reflecting the function of the amygdala 5-HTT gene network, interacts with postnatal adversity, to predict attention and hyperactivity problems across both cohorts. Also, both postnatal adversity score and amygdala ePRS-5-HTT score, as well as their interaction, were observed to be associated with variation in DNA methylation across the genome. Variations in gray matter density in brain regions linked to attentional processes were also correlated to our ePRS score. These results confirm that the amygdala 5-HTT gene network is strongly associated with ADHD-related behaviors, brain cortical density, and epigenetic changes in the context of adversity in young children.

Background The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods: two before (2000–2003 and 2004–2008) and one after (2009–2014) the onset of the 2008 financial crisis. Methods This is an ecological study of trends. The units of analysis were small areas within nine European urban areas. We used a composite deprivation index as a socio-economic indicator. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollie. To analyze the evolution of socio-economic inequalities, we fitted an ecological regression model that included the socio-economic indicator, the period of time, and the interaction between these terms. Results In men, socio-economic inequalities in all-cancer and lung cancer mortality were observed in most of the cities studied, but did not increase after the onset of the economic crisis. In women, only two cities (Stockholm and London) showed socio-economic inequalities in all-cancer and lung cancer mortality; there was also no increase in inequalities. Conclusions Our results did not validate our hypothesis that inequalities increase in times of crisis. However, they emphasize the importance of socio-economic measurements for understanding mortality inequalities, and can be used to inform prevention strategies and help plan local health programs aimed at reducing health inequalities.

We report a study on toxoplasmosis in pregnant women in Luanda, Angola, determining the seroprevalence, geospatial distribution and its association with socio-economic features, dietary habits and hygiene and health conditions. Anti-Toxoplasma gondii IgG and IgM were quantified in serum samples of women attended at the Lucrecia Paim Maternity Hospital between May 2016 and August 2017. The IgG avidity test and qPCR assay were used for dating the primary infection. Data were collected by questionnaire after written consent, and spatial distribution was assessed through a Kernel Density Function. The potential risk factors associated with Toxoplasma infection were evaluated using bivariate and multivariate binomial logistic regression analysis. Anti-T. gondii antibodies were quantified in 878 pregnant women, and 346 (39.4%) samples were IgG positive, 2 (0.2%) positive for IgM and IgG, and 530 (60.4%) negative for both immunoglobulins. The longitudinal study showed that none of the seronegative women seroconverted during the survey. Regarding other infections, 226 (25.7%) were positive for hepatitis B, while 118 (13.4%) were HIV-positive. The seroprevalence of toxoplasmosis was similar in most municipalities: 43.8% in Cazenga (28 of 64); 42.5% in Viana (88 of 207); 42.3% in Cacuaco (22 of 52); and 41.1% in Luanda ((179 of 435). In contrast, the seroprevalence in municipality of Belas was lower (25.8%; 31 of 120) and bivariate and multivariate analysis has shown a lower risk for toxoplasmosis in this area (OR 0.479, CI: 0.305–0.737; OR 0.471, CI: 0.299–0.728). The multivariate analysis has shown a significant increased risk for toxoplasmosis in women in the last trimester of pregnancy (OR 1.457, CI: 1.011–2.102), suffering spontaneous abortion (OR 1.863, CI: 1.014–3.465) and having pets at home (OR 1.658, CI: 1.212–2.269). Also, women who tested positive for hepatitis B (OR 1.375, CI: 1.008–1.874) and HIV (OR 1.833, CI: 1.233–2.730) had a significant increased risk for T. gondii infection. In conclusion, our study showed that a large number of pregnant women are not immunized for toxoplasmosis and identified the risk factors for this infection in Luanda. It is crucial to establish the diagnosis of primary maternal infection as well as the diagnosis of congenital toxoplasmosis. Our results underlined the need for diagnostic and clinical follow-up of toxoplasmosis, HIV and hepatitis B during pregnancy.

Background Depression is a major cause of chronic disability throughout the world and an important cardiovascular risk factor, increasing the relative risk of coronary artery disease as well as rates of cardiovascular morbidity and mortality. Concomitant to the high prevalence of depression, there has been a reduction in exposure to sunlight with the increase in urbanization and the use of sun protectors, which has led to a reduction in serum levels of 25-hydroxyvitamin D. Therefore, this paper describes a protocol for a clinical trial with the aim of evaluating the effects of vitamin D supplementation on depression and cardiovascular risk factors to contribute evidence regarding the potential influence of supplementation on mood regulation. Methods This protocol study was guided by the Standard Protocol Items: Recommendations for Interventional Trials. A randomized, placebo-controlled, double-blind clinical trial will be conducted involving 224 adults (age range 18–60 years) with depression who are taking antidepressants and have no history of vitamin D supplementation, psychiatric comorbidities, chronic kidney disease, hypercalcemia, or neoplasm. The participants will be recruited from the psychiatric outpatient clinics of two universities in northeast Brazil. Eligible participants who provide written consent will be randomly designated to either the intervention group (n = 112; vitamin D supplementation 50,000 IU per week for 6 months) or the control group (n = 112; placebo taken weekly for 6 months). Measures for monitoring depressive symptoms, clinical examinations, and laboratory tests for evaluating cardiovascular risk factors and serum vitamin D levels will be performed before and after the intervention period. Discussion To the best of our knowledge, this will be the first clinical trial with the aim of testing the effectiveness of vitamin D supplementation on the reduction of cardiovascular risk and as an adjuvant to depression therapy for a prolonged period (6 months). The findings will contribute to the understanding of the therapeutic effects of vitamin D supplementation in the management of depression and can help guide public policies directed toward vitamin supplementation for the reduction of cardiovascular risk. Trial registration Brazilian Clinical Trials Registry, RBR-6yj8sj/Universal Trial Number (UTN) U1111-1217-9237. Registered on 23 July 2018.

Fissuras labiais e/ou palatinas não sindrômicas (FL/PNS) representam a anomalia congênita mais comum em humanos. Entretanto, são poucos os estudos que analisam a curvatura e dilaceração em pacientes acometidos pela FL/PNS. O objetivo deste estudo foi avaliar a prevalência de dilaceração radicular em 400 indivíduos portadores de FL/PNS, assim como relacionar o grau de curvatura da raiz com os diferentes tipos de fissuras. Observou-se que raízes de pré-molares e molares apresentaram diferentes direções (p

Objetivo: Avaliar os efeitos da prática de exercício físico de diferentes tipos e intensidades sobre a estimulação do sistema imunológico nos portadores do HIV, bem como os benefícios para a saúde e bem-estar dos indivíduos imunossuprimidos. Revisão bibliográfica: O HIV possui uma alta afinidade pelas células do sistema imunológico, em particular os linfócitos TCD4+, proporcionando uma diminuição na quantidade e qualidade desse complexo. Assim, além dos tratamentos medicamentosos, há também recomendações da prática de exercício físico de forma regular, que auxiliam na estimulação do sistema imunológico, bem como contribuem no controle dos efeitos adversos acarretados pela terapia antirretroviral, sem gerar sequelas no sistema imune, melhorando as medidas antropométricas e funcionais do paciente. Com isso, a atividade física deve ser indicada a afim de favorecer tanto à reconstituição do sistema imunológico, quanto uma melhora na saúde mental do indivíduo. Considerações finais: Este constructo é de fundamental importância, pois irá prover embasamento teórico-metodológico para mais pesquisas sobre a relação da atividade física e a melhora da qualidade de vida dos pacientes portadores do HIV.

While the government responses to the COVID-19 pandemic have varied across the globe, there has been a unifying cry from academia and public health professionals warning of the detrimental effects of attaching our understanding of this new threat to our already ageist attitudes. What is inescapable is that COVID-19 has an age-related risk component and the latest data shows that risks start to rise for people from midlife onwards. As governance agencies, professional practice, and academia work towards assessing, communicating, and addressing this risk, we ask: are existing gerontological conceptualisations of ageism appropriate for this exceptional situation and what is being (re)produced in terms of an aged subjectivity? Following van Dyk's (2016) critique of gerontology's 'othering' through both 'glorification' (third age) and 'abjection' (fourth age), a content analysis of statements and policy documents issued in response to COVID-19 provides evidence of well-meaning and inadvertent ageism through homogenizing language, the abjection/glorification binary within 'old age', and the power binary constructed between age and an age-neutral midlife. The paper concludes with reflections on future directions for ageism research beyond COVID-19.

The increasing worldwide demand for energy bound to a strong dependence of fossil fuels has considerably intensified the concentration of greenhouse gases in the atmosphere, reaching alarming levels. Among those gases, carbon dioxide is considered the main responsible for global warming due to its higher concentration. In order to mitigate the negative effects of global warming and to reduce emissions, many technologies have been developed in the last decades to separate and recover carbon dioxide (CO 2 ) at different capture scenarios. Adsorption processes rely on the use of highly porous solids such as activated carbons, which are either commercially. Pressure Swing Adsorption (PSA) is a cyclic adsorption process, which allows continuous separation of gas streams. PSA is performed by periodic changes of pressure aiming the optimization of contaminants removal and is considered viable for separation of CO 2 from flue gases containing about 5-15% v/v. To achieve a certain performance, a PSA process may consist of several steps, columns and cycle time. One of the most basic configurations comprises four steps: pressurization, feed, blowdown and purge. The performance of a PSA process is usually evaluated by the purity, recovery and productivity reached. This study presents experimental and simulated data obtained from a bench-scale PSA, with a maximum pressure of 6 bar for pressurization and feed steps and minimum of 1 bar for blowdown and purge steps. The unit was tested with a mixture containing 85% of N 2 and 15% of CO 2 (on a molar basis). Carbon dioxide and nitrogen breakthrough curves were obtained under typical conditions of post combustion capture. A mathematical-phenomenological model combining momentum, mass and heat balances and using the Linear Driving Force approach (LDF) for mass transport and Langmuir model for equilibrium was applied in this study to simulate the dynamic behavior of the process. The performance tests presented productivity of 15 mol h -1 kg-ads -1 and, according to the changes of step time, N 2 purity of 97.7%. The model predicted reasonably the breakthrough curves and temperature profiles, with more precision for the latter. The combination of the simulation tool with and experimental PSA unit is very valuable for a deeper understanding of the involved phenomena and helpful with the design of optimized and efficient CO 2 adsorption-based capture processes.

The aim of this study is to estimate the mortality burden attributable to low temperature in Athens, Lisbon and London from 2002 to 2011 and to discuss related inequalities in socioeconomic conditions. We address a lack of quantitative estimates of cold-related mortality, particularly for the cities of Lisbon and Athens. To estimate the mortality burden attributable to low temperature, time-series regression analyses were carried out on daily mortality with respect to daily mean temperature for the three metropolitan areas to estimate the relative risk associated with a decrease in temperature. The number of cold-related deaths was estimated using the population Attributable Fraction. Lisbon presents higher relative risk (RR) than London and Athens; the RR for Athens is lower than for London. The coldrelated death rate is higher in Lisbon (53.2 deaths per 100,000 inhabitants) than in Athens (32.6) and London (37.6). The spatial heterogeneity between the three metropolitan areas in the risk estimates and cold-related mortality may result from the significant disparities in the built environment. Adequate public health planning and preventive measures in the built environment may help reduce cold-related deaths and decrease vulnerability to cold in European cities.

Background Patients undergoing bariatric surgery can have respiratory complications in addition to vomiting and ileus. Esmolol can decrease the consumption of opioids, reducing their side effects. The purpose of this study was to evaluate the analgesic effect of esmolol in patients allocated to laparoscopic gastroplasty. Methods Forty patients between 18 and 50 years old, of both genders, physical status ASA I-II, who underwent bypass gastroplasty were divided into two groups. Participants in group 1 received a 0.5 mg/kg bolus of esmolol in 30 mL of saline before induction of anesthesia, followed by infusion of 15µg/kg/min until the end of surgery; those in group 2 received 30 mL of saline bolus and infusion of solution in the same volume as group 1. The anesthesia included fentanyl (5ug/kg), propofol (2-4 mg/kg), rocuronium (0.6 mg/kg), 50% oxygen without nitrous oxide and 2% sevoflurane, with remifentanil if necessary. There were evaluated: remifentanil consumption, time to analgesic supplementation, pain intensity for 24 h and morphine dose over 24 h. Side effects were noted. Results Intraoperative remifentanil supplementation, time to recovery, and postoperative morphine supplementation were lower in the esmolol group; there was no difference in time for the first supplementation. Pain intensity was lower, except at T0 and after 12 h. There were no differences in side effects. Conclusions Intraoperative esmolol promotes an analgesic effect without causing adverse effects, making it an effective drug for multimodal analgesia for gastroplasty.

Background The ability to measure regional health inequalities across Europe and to build adequate population health indices depends significantly on the availability of reliable and comparable data at the regional level. Within the scope of the EU-funded project EURO-HEALTHY, a Population Health Index (PHI) was built. This model aggregates 39 indicators considered relevant by experts and stakeholders to evaluate and monitor population health on the regional level within the European Union (269 regions). The aim of this research was to assess the data availability for those indicators. As a subsequent aim, an adequate protocol to overcome issues arising from missing data will be presented, as well as key messages for both national and European statistical authorities meant to improve data collection on population health. Methods The methodology for the study includes three consecutive phases: (i) assessing the data availability for the respective indicators at the regional level for the last year available (ii) applying a protocol for missing data and completing the database and (iii) developing a scoring system ranging from 0 (no data available; worst) to 1 (all data available; best) to evaluate the availability of data by indicator and EU region. Results Although the missing data on the set of the PHI indicators was significant, the mean availability score for the EURO-HEALTHY PHI indicators is 0.8 and the regional availability score is 0.7, which reveal the strength of the indicators as well as the data completeness protocol for missing data. Conclusions This study provides a comprehensive data availability assessment for population health indicators from multiple areas of concern, at the EU regional level. The results highlight that the data completeness protocol and availability scores are suitable tools to apply on any indicator’s data source mapping. It also raises awareness to the urgent need for sub-national data in several domains and for closing the data gaps between and within countries. This will require policies clearly focused on improving equity between regions and a coordinated effort from the producers of data (the EU28 national statistics offices and EUROSTAT) and the stakeholders who design policies at EU, regional and local level. Electronic supplementary material The online version of this article (10.1186/s12963-019-0188-6) contains supplementary material, which is available to authorized users.

Mental health is an intrinsic dimension of health influenced by individual and contextual factors. This cross-sectional study analyzes the association between the individual, neighborhood characteristics, and one&rsquo, s self-assessed mental health status in the Lisbon region after an economic crisis. Via the application of multilevel regression models, the study assesses the link between one&rsquo, s neighborhood environment&mdash, deprivation, low self-assessed social capital, and low self-assessed satisfaction with the area of residence&mdash, and mental health regardless of one&rsquo, s individual characteristics. Constraints related to the economic crisis play an important role in the explanation of poor mental health.

Early life experiences have strong influences on brain programming and can affect eating behavior control and body weight later in life. However, there is no consensus about the relationship between neonatal stress and feeding behavior. We evaluated whether maternal deprivation (MD) and maternal separation (MS) alter body weight and appetite using standard rat chow consumption and palatable food. Also, we evaluated anxiety and the expression of the leptin receptor, neuropeptides POMC, CART, NPY in the hypothalamus, as well as the serotoninergic system in the amygdala and hypothalamus as possible modulators of these behaviors. We found a decrease in standard rat chow consumption in MD. However, both neonatal stress protocols increased the consumption of palatable food and led to anxiogenic behavior in male animals. MD led to decreased hypothalamic POMC levels in adult males. Serotonin in the hypothalamus was decreased by both stress models in males and females. In the amygdala, MS decreased serotonin levels while MD increased its metabolite levels. We observed that males are more vulnerable and females are more resilient to the effects of neonatal stress on anxiety-like behavior, as well as on food consumption and on the central changes observed. These data together add support to the concept that the early environment contributes to the development of eating disorders later in life.

A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO 2 ), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO 2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO 2 respectively. The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO 2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population.

Este artículo discute sobre las diversas concepciones de fluidez en la Lingüística, Fonoaudiología y Neurosicología. El texto sostiene que la fluidez debe ser considerada a partir de su carácter multifactorial y condición heterogénea en la clínica de lenguaje. Los datos de lenguaje, en tres casos clínicos: tartamudez, afasia progresivaprimaria y demencia de Alzheimer, se analizan de acuerdo con la Neurolinguística Enunciativo-Discursiva. Así, se observa que el concepto de fluidez es construido de manera particular en las áreas de Lingüística, Fonoaudiología y Neuropsicología, y, también, que la interpretación de fluidez, en cada una de ellas, no se presenta de manera uniforme, no es un concepto acabando, resaltando la necesidad de reflexión de la fluidez como aspecto inherente a la lengua en sus varias normas posibles., Este artigo discute sobre as diversas concepções de fluência na Linguística, Fonoaudiologia e Neuropsicologia. O texto defende que a fluência deve ser considerada a partir de seu caráter multifatorial e condição heterogênea na clínica de linguagem. Os dados de linguagem, em três casos clínicos: gagueira, afasia progressiva primária e demência de Alzheimer, são analisados de acordo com a Neurolinguística Enunciativo-Discursiva. Assim, observa-se que o conceito de fluência é construído de maneira particular nas áreas de Linguística, Fonoaudiologia e Neuropsicologia, e, também, que a interpretação de fluência, em cada uma delas, não se apresenta de maneira uniforme, não é um conceito acabado, ressaltando a necessidade de reflexão da fluência enquanto aspecto inerente à língua em suas várias normas possíveis., This paper discusses different conceptions of fluency in Linguistics, Speech Therapy and Neuropsychology. The text indorses that fluency should be considered from its multifactorial character and heterogeneous condition in the language clinic. Language data are analyzed according to the Enunciative-Discursive Neurolinguistics, considering three clinical cases: stuttering, primary progressive aphasia and Alzheimer's dementia. Thus, it is observed that the concept of fluency is constructed in a particular way in the areas of Linguistics, Speech-Language Pathology and Neuropsychology. Also it is observed that the interpretation of fluency in each one of them is not presented in a uniform way as it is not a completed concept; for that reason, it emphasizes the need for reflection on the fluency as an inherent aspect of the language in its various possible norms.

The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authorities. The complexity of measuring health, which at the same time underscores the level of intra-urban inequalities, calls for integrated and multidimensional approaches. The aim of this study is to analyse inequalities in health determinants and health outcomes across and within nine metropolitan areas: Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm and Turin. We use the EURO-HEALTHY Population Health Index (PHI), a tool that measures health in two components: Health Determinants and Health Outcomes. The application of this tool revealed important inequalities between metropolitan areas: Better scores were found in Northern cities when compared with their Southern and Eastern counterparts in both components. The analysis of geographical patterns within metropolitan areas showed that there are intra-urban inequalities, and, in most cities, they appear to form spatial clusters. Identifying which urban areas are measurably worse off, in either Health Determinants or Health Outcomes, or both, provides a basis for redirecting local action and for ongoing comparisons with other metropolitan areas. This research was conducted under the EURO-HEALTHY project, which was funded by the European Union’s Horizon 2020 research and innovation programme, Grant Agreement No 643398, and received support from the Centre of Studies in Geography and Spatial Planning (CEGOT), funded by national funds through the Foundation for Science and Technology (FCT) under the reference UID/GEO/04084/2013.

Cerebrovascular diseases are the leading cause of mortality in Portugal, especially when related with extreme temperatures. This study highlights the impacts of the exposure-response relationship or lagged effect of low and high temperatures on cerebrovascular mortality, which can be important to reduce the health burden from cerebrovascular diseases. The purpose of this study was to assess the effects of weather on cerebrovascular mortality, measured by ambient temperature in the District of Lisbon, Portugal. A quasi-Poisson generalized additive model combined with a distributed lag non-linear model was applied to estimate the delayed effects of temperature on cerebrovascular mortality up to 30 days. With reference to minimum mortality temperature threshold of 22 °C, there was a severe risk (RR = 2.09, 95% CI 1.74, 2.51) of mortality for a 30-day-cumulative exposure to extreme cold temperatures of 7.3 °C (1st percentile). Similarly, the cumulative effect of a 30-day exposure to an extreme hot temperature of 30 °C (99th percentile) was 52% (RR = 1.65, 95% CI 1.37, 1.98) higher than same-day exposure. Over the 13 years of study, non-linear effects of temperature on mortality were identified, and the probability of dying from cerebrovascular disease in Lisbon was 7% higher in the winter than in the summer. The findings of this study provide a baseline for future public health prevention programs on weather-related mortality.

Background Individuals with mental disorders are often susceptible to the effects of extreme ambient temperatures. The aim of this study is to assess the short-term impacts of daily mean temperature on hospitalizations for mental disorders in the Lisbon Metropolitan Area, Portugal. Methods To assess the short-term impacts of daily mean temperature on hospitalizations for mental disorders (2008–2014), a quasi-Poisson generalized additive model combined with a distributed lag non-linear model was applied. The model was adjusted for day of the week, air pollution, relative humidity, time and seasonality. Results The number of hospital admissions for mental disorder during the study period was 30,139. Hospital admissions increase significantly with high temperatures on day of exposure, at lag 0–1 and at lag 0–2. Women are more vulnerable than men, and there was no difference between the age groups studied. Conclusions The exposure to high temperatures should be considered a significant risk factor for mental disorders; therefore, patient management services may need to be strengthened when extreme high temperature alerts are given.