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Introduction: The metabolic syndrome consists of a set of factors that, when associated, are associated with a higher risk of developing cardiovascular diseases and type 2 diabetes, and is thus an important public health problem. The objective of this study was to estimate the prevalence of this syndrome in the Portuguese population, and to evaluate possible associations with demographic and socioeconomic determinants. Material and Methods: Based on the 1st National Health Survey with Physical Examination of 2015, a cross-sectional epidemiological study was conducted on a representative sample of the Portuguese population (n = 4797) aged between 25 and 74 years old. The prevalence was estimated for the total population and each gender, stratified by age group, health region, type of urban area, marital status, education, professional status, and risk of poverty. The magnitude of the associations was measured with adjusted prevalence ratios. Results: In the Portuguese population the estimated prevalence was 33.4% [95% CI, 31.7 – 35.1] [35.6% in men (95% CI, 31.9 – 39.2) and 31.3% in women (95% CI, 28.5 – 34.2)]. In both genders, the highest prevalence was significantly associated with increasing age, widowed/married/de facto partners and those with lower levels of education. There was no association with gender, health region, type of urban area, professional status or risk of poverty. Discussion: This syndrome was present in a third of the Portuguese population. The knowledge of its epidemiology enables the identification of population groups with higher cardiovascular and metabolic risk. Conclusion: Metabolic syndrome was independently associated with specific groups. This knowledge reinforces the importance of a holistic assessment of the health determinants associated with the metabolic syndrome.

The changes deriving from the birth of a child with a congenital anomaly (CA) or cerebral palsy (CP) imply, in many cases, an increased interaction with health services. A cross-sectional descriptive study was conducted with a convenience sample of parents of children diagnosed with four groups of CA (severe heart anomalies, spina bifida, orofacial clefts, and Down syndrome) and/or CP. A semistructured online questionnaire to be answered by parents was sent by web link to focal points of five parent associations and professional institutions. Data were analyzed through thematic content analysis (open-ended questions) and descriptive analysis (closed-ended questions). The results indicate consistency of responses of parents of children diagnosed with different conditions, namely with respect to the perception of health services and professionals. Closed and open-ended responses indicated three main topics in the interaction between health services and parenthood: information, coordinated and integrated responses, and support. The less positive outcomes suggest unmet information needs, while positive aspects include confidence in the care provided and the “training” received from health professionals.

ObjectivesHealthcare workers (HCWs) were the first to be prioritised for COVID-19 vaccination. This study aims to estimate the COVID-19 vaccine effectiveness (VE) against SARS-CoV-2 symptomatic infection among HCWs in Portuguese hospitals.DesignProspective cohort study.Setting and participantsWe analysed data from HCWs (all professional categories) from three central hospitals: one in the Lisbon and Tagus Valley region and two in the central region of mainland Portugal, between December 2020 and March 2022. VE against symptomatic SARS-CoV-2 infection was estimated as one minus the confounder adjusted HRs by Cox models considering age group, sex, self-reported chronic disease and occupational exposure to patients diagnosed with COVID-19 as adjustment variables.ResultsDuring the 15 months of follow-up, the 3034 HCWs contributed a total of 3054 person-years at risk, and 581 SARS-CoV-2 events occurred. Most participants were already vaccinated with a booster dose (n=2653, 87%), some are vaccinated with only the primary scheme (n=369, 12.6%) and a few remained unvaccinated (n=12, 0.4%) at the end of the study period. VE against symptomatic infection was 63.6% (95% CI 22.6% to 82.9%) for HCWs vaccinated with two doses and 55.9% (95% CI −1.3% to 80.8%) for HCWs vaccinated with one booster dose. Point estimate VE was higher for individuals with two doses taken between 14 days and 98 days (VE=71.9%; 95% CI 32.3% to 88.3%).ConclusionThis cohort study found a high COVID-19 VE against symptomatic SARS-CoV-2 infection in Portuguese HCWs after vaccination with one booster dose, even after Omicron variant occurrence. The small sample size, the high vaccine coverage, the very low number of unvaccinated individuals and the few events observed during the study period contributed to the low precision of the estimates.

Lymphoma is the most common haematological malignancy in dogs and its aetiology is largely unknown. The presence of canine vector-borne agents (CVBD) in lymphoma tissues has been described and its causative effects questioned. We intended to evaluate the presence and extent of Leishmania infantum, Ehrlichia canis, Anaplasma phagocytophilum and Bartonella henselae infection in dogs with lymphoma. Sixty-one dogs, living in the Lisbon metropolitan area, with a diagnosis of lymphoma were enrolled. Immunofluorescence assays were used to detect serum IgG's. The presence of DNA from CVBD agents in tumour tissue was assessed by PCR. All dogs tested negative for B. henselae, A. phagocytophilum and E. canis by both serology and PCR. Regarding L. infantum, 8.2% (n = 5) of the dogs had a positive serologic result. L. infantum DNA was detected in two samples of diffuse large B-cell lymphoma (DLBCL). These results show an increased, but not significant, seropositivity (8.2% vs 7.9%) and molecular detection (3.3% vs 1.2%) for L. infantum in dogs with lymphoma, when compared to the reported canine population in the same geographical area. We could not identify an association between lymphoma and E. canis, A. phagocytophilum, B. henselae or Leishmania infantum infection in the studied population. Nevertheless, further studies, following dogs trough their CVBD disease evolution, are worthwhile and may help clarify a possible role of CVBD agents in lymphomagenesis. Bayer Animal Health- Portugal info:eu-repo/semantics/publishedVersion

Although concerns about the environment have been raised by some governments and the public in general, literature has explored the possibility that Foreign Direct Investment (FDI) may flow from countries with strict environmental regulations to countries where the regulations are less stringent-the pollution haven hypothesis (PHH). In response to that tendency, some countries may implement less stringent regulations, in order to attract FDI, resulting in the race to the bottom effect (RTB). As the number of studies on this topic has expanded dramatically in the last two decades, the present work intends to provide an updated literature review on the relationship between FDI and environmental regulations. Through a bibliometric analysis, we evaluate the relevance of existing studies and identify possible trends. Results show that there is considerable empirical evidence for the PHH, but fewer studies confirm the RTB, and that topic has been increasingly analysed.

This study intended to identify and quantify the social ecological model (SEM) levels associated to seasonal IV uptake in the Portuguese elderly population. Data from the 2014 National Health Survey was restricted to individuals aged 65+ years (n = 5669). Twenty-three independent variables were allocated to the SEM levels: individual, interpersonal, organizational, community and policy. Sex stratified and age adjusted analysis using Poisson regression were performed for each level and for a fitted full model. Relative reduction in pseudo R magnitude measured marginal contribution of each level. For men and women, older groups (85+ vs. 65–69; men, PR = 1.59 and women, PR = 1.56); having 3+ chronic conditions (men, PR = 1.39 and women, PR = 1.35); previous 4 weeks GP and outpatient visits were associated to higher IV uptake. For men, only 2 SEM levels were associated (individual and organizational) while for women the community level was also relevant. Main marginal contribution came from individual (17.9% and 16.3%) and organizational (30.7% and 22.7%) levels. This study highlights the importance of individual characteristics, access and use of health care services for the IV uptake and the sex differential behaviour.

Background Participation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe strategies used by the local teams to increase participation rates and to solve practical survey problems.Methods After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. 41 of the local staff members also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.Results The local teams believed that the detailed manual, described as a "cookbook for making a health examination survey", made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.Conclusions The theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.A detailed manual covering standard procedures and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

ObjectiveTo survey parents and carers of children with a congenital anomaly across Europe about their experiences of healthcare services and support during the COVID-19 pandemic.DesignCross-sectional study.SettingOnline survey in 10 European countries, open from 8 March 2021 to 14 July 2021.Population1070 parents and carers of children aged 0–10 years with a cleft lip, spina bifida, congenital heart defect (CHD) requiring surgery and/or Down syndrome.Main outcome measuresParental views about: the provision of care for their child (cancellation/postponement of appointments, virtual appointments, access to medication), the impact of disruptions to healthcare on their child’s health and well-being, and satisfaction with support from medical sources, organisations and close relationships.ResultsDisruptions to healthcare appointments were significantly higher (pConclusionA large proportion of participants reported disruptions to healthcare during the pandemic, which for some had a significant impact on their child’s health. Regional differences in disruptions raise questions about the competence of certain healthcare systems to meet the needs of this vulnerable group of patients and indicate improvements should be strived for in some regions.

© 2019 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, ˜ S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)., INTRODUCTION AND OBJECTIVES: Recent updates on Pulmonary Rehabilitation highlight the importance of patients' self-efficacy on long-term adherence to health-enhancing behaviors. The Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) is an adaptation of the General Self-Efficacy Scale. This study aimed to translate, culturally adapt and evaluate reliability and validity of PRAISE in Portuguese respiratory patients. PATIENTS OR MATERIALS AND METHODS: Forward-backward translation and pilot testing were performed. Content validity was assessed by a multidisciplinary panel of expert judges. To evaluate reliability and validity, 150 respiratory outpatients on Pulmonary Rehabilitation participated in a cross-sectional study. Descriptive and reliability analyses, and exploratory factorial analysis using principal axis factoring, followed by oblique oblimin factor rotation were conducted to identify construct validity. IBM® SPSS® version 22 was used to perform statistical analysis. RESULTS: 150 patients with a mean age of 67 years, 54% male and 83% currently on Pulmonary Rehabilitation participated in the study. These included mainly Chronic Obstructive Pulmonary Disease patients (46.7%) but also Bronchiectasis (20%), Interstitial Lung Disease (20%) and other respiratory diseases. PRAISE mean score was 49. Exploratory factor analysis extraction provided a 4-factor solution that cumulatively explained 52.3% of total variance (F1: 26.6%; F2: 9.7%; F3: 8.7%; F4: 7.3%). Portuguese PRAISE showed a reliability of 0.78 (Chronbach alpha). CONCLUSIONS: The Portuguese version of PRAISE showed adequate psychometric properties for it to be used as an instrument to measure self-efficacy as a patient-centered outcome on Pulmonary Rehabilitation., This work was supported by Fundação para a Ciência e Tecnologia (FCT) and Nippon Gases Portugal under the PhD studentship in Industry grant PDE/BDE/127785/2016.

Vaccination is considered the most important measure to control the COVID-19 pandemic. Extensive follow-up studies with distinct vaccines and populations are able to promote robust and reliable data to better understand the effectiveness of this pharmacologic strategy. In this sense, we present data regarding binding and neutralizing (achieved by surrogate ELISA assay) antibodies throughout time, from vaccinated and previously infected (PI) health care workers (HCW) in Portugal. We analyzed serum samples of 132 HCW, who were vaccinated and with previous SARS-CoV-2 infection. Samples were collected before vaccination (baseline, M1), at second dose vaccine uptake (M2), and 25–70 days (M3) and 150–210 days (M4) after the second dose for vaccinated individuals. The IgG (anti-RBD/S) antibody geometric mean titers found on vaccinated HCW at M2 (GM = 116.1 BAU/mL; CI: 92.3–146.1) were significantly higher than those found on PI HCW at recruitment (M1) (GM = 35.9 BAU/mL; CI:15.4–83.4), and the neutralizing antibodies (nAb) were similar between these groups, of 93.2 UI/mL (95% CI 73.2–118.5) vs. 84.1 UI/mL (95% CI 40.4–155.9), respectively. We detected around 10-fold higher IgG (anti-RBD/S) antibodies titers in M3 when compared with M2, with a slight but significant decrease in titers from 36 days after the second dose vaccine uptake. The increase of nAb titers was correlated with IgG (anti-RBD/S) antibodies titers; however, in contrast to IgG (anti-RBD/S) antibodies titers, we did not detect a decrease in the nAb titer 36 days after a second vaccine dose uptake. At M4, a decrease of 8-fold in binding IgG (anti-RBD/S) and nAb was observed. No significant differences in antibody titers were observed by sex, age or chronic diseases. Our results suggest that IgG (anti-RBD/S) antibodies titers and nAb titers could be correlated, but an ongoing follow up of the cohort is required to better understand this correlation, and the duration of the immune response.

Vaccination is considered the most important measure to control the COVID-19 pandemic. Extensive follow-up studies with distinct vaccines and populations are able to promote robust and reliable data to better understand the effectiveness of this pharmacologic strategy. In this sense, we present data regarding binding and neutralizing antibodies throughout time, from vaccinated and previously infected (PI) health care workers (HCW) in Portugal. We analyzed serum samples of 132 HCW, vaccinated and with previous SARS-CoV-2 infection. Samples were collected before vaccination (baseline, M1), at second dose vaccine uptake (M2), and 25-70 days (M3) and 150-210 days (M4) after the second dose for vaccinated individuals. The IgG (anti-RBD/S) antibody geometric mean titer found on vaccinated HCW at M2 (814.7 AU/ml; 95% CI 649.8-1021.5) were significantly higher than those found on PI HCW at recruitment (M1) (252.6 AU/ml; 95% CI 108.7 - 587.1), and the neutralizing antibodies (nAb) were similar between these groups, 93.2 UI/ml (95% CI 73.2-118.5) vs. 84.1 UI/ml (95% CI 40.4-155.9), respectively. We detected about 10-fold higher IgG (anti-RBD/S) antibodies titers in M3 when compared with M2, with a slightly but significant decrease in titers from 36 days after the second dose vaccine uptake. The increase of nAb titers were correlated with IgG (anti-RBD/S) antibodies titers, however, contrasting to IgG (anti-RBD/S) antibodies titers, we did not detect a decrease in nAb titer from 36 days after a second vaccine dose uptake. At M4, was observed a decrease of 8-fold in binding IgG (anti-RBD/S) and nAb. No significant differences in antibody titers were observed by sex, age or chronic diseases. Our results suggest that IgG (anti-RBD/S) antibodies titers and nAb titers could be correlated, but ongoing follow up of the cohort, is required to better understand this correlation, and the duration of the immune response.

Background Limited research evidence exists on the development of web-based platforms for reciprocal communication, coproduction research, and dissemination of information among parents, professionals, and researchers. This paper provides learning and the outcomes of setting up a bespoke web-based platform using social media. Objective This study aims to explore the establishment of a web-based, multicontextual research communication platform for parents and stakeholders of children with congenital anomalies using social media and to identify associated research and ethical and technical challenges. Methods The ConnectEpeople e-forum was developed using social media platforms with a stakeholder engagement process. A multilevel approach was implemented for reciprocal engagement between parents of children with congenital anomalies, researchers, health care professionals, and other stakeholders using private and invisible and public Facebook groups, closed Twitter groups, and YouTube. Ethical approval was obtained from Ulster University. Results Nonprofit organizations (N=128) were invited to engage with an initial response rate of 16.4% (21/128). Of the 105 parents contacted, 32 entered the private and invisible Facebook groups to participate in the coproduction research. Public Facebook page followers rose to 215, a total of 22 posts had an engagement of >10%, and 34 posts had a reach of over 100. Webinars included requested information on childhood milestones and behavior. YouTube coverage included 106 ConnectEpeople videos with 28,708 impressions. Project information was obtained from 35 countries. The highest Facebook activity occurred during the early morning hours. Achievement of these results required dedicated time management, social media expertise, creativity, and sharing knowledge to curate valuable content. Conclusions Building and maintaining a multilayered online forum for coproduction and information sharing is challenging. Technical considerations include understanding the functionality and versatility of social media metrics. Social media offers valuable, easily accessible, quantitative, and qualitative data that can drive the reciprocal process of forum development. The identification and integration of the needs of the ConnectEpeople e-forum was a key driver in the dissemination of useful, meaningful, and accessible information. The necessary dedicated administration to respond to requests and posts and collate data required significant time and effort. Participant safety, the development of trust, and the maintenance of confidentiality were major ethical considerations. Discussions on social media platforms enabled parents to support each other and their children. Social media platforms are particularly useful in identifying common family needs related to early childhood development. This research approach was challenging but resulted in valuable outputs requiring further application and testing. This may be of particular importance in response to COVID-19 or future pandemics. Incorporating flexible, adaptable social media strategies into research projects is recommended to develop effective platforms for collaborative and impactful research and dissemination.

Background The practice of high perfomance sports leads to alterations of the autonomic nervous system (ANS). The study of heart rate variability (HRV) resorting to the electrocardiogram (ECG) is a practical, efficient and non invasive tool that allows the monitorization of the cardiac-autonomic function in high perfomance athletes, exposing the physiological adaptations to repeated and intense physical exercise. To evaluate the resting heart rate variability of futsal players resorting to the electrocardiogram during the pre-season and competitive season. Methods The sample used in this study was composed of fifteen male futsal athletes, subjected to a resting electrocardiogram in supine position with the duration of 6 minutes, at two different moments. Results From the first to the second record heart rate variability, it was observed a significant decrease in heart rate from 66.53 ± 10.39 bpm to 61.50 ± 11.14 bpm (P < 0.05) and the indexes related to the activity of the parasympathetic nervous system (PNS), RMSSD, pNN50, HFnu did not present statistical significance (P > 0.05) despite the verified increased of absolute values from the first to the second evaluation. Conclusions We were able to observe a decrease in heart rate (HR), as well as, a tendency for elevated parasympathetic indexes and a vagal predominance from the first to the second moment of evaluation. The monitorization of heart rate variability can be useful to identify adaptations to competitive loads and, thus, planning adequate training loads for each athlete, avoiding the occurrence of lesions and fatigue and allowing an improvement in performance.

Three novel Bouligand inspired composites were produced by vacuum bag infusion manufacturing process and their quasi-static mechanical performance were compared to a conventional aircraft laminate. A morphologic/physical study was first conducted for all configurations and their mechanical response under tensile, three-point bending (3-PB) and interlaminar shear strength (ILSS) tests were then evaluated and discussed. No significant number of voids were detected into laminates, however, a rough and poor defined interlaminar region was observed in both Bouligand-like configurations. Under quasi-static mechanical solicitations, and when compared to reference layup, bioinspired configurations have shown similar and 18% higher tensile and flexural modulus. However, the progressive and translaminar failure mode, typically observed in these configurations, led to a lower load bearing capability. Despite presented similar interlaminar resistance than reference, finite element models built have revealed a good correlation between cross-section stress field and failure mode observed experimentally., Fundação para a Ciência e Tecnologia (FCT), Projetos UIDB/05256/2020, UIDP/05256/2020 e MITP-TB/PFM/0005/2013

Sunlight exposure is responsible for a large number of dermatological diseases. The purpose of this study was to estimate the prevalence of hazardous sun exposure and adherence to sun protective behaviours and its associated factors in adults from the Portuguese population. A total of 4,797 participants aged between 25 and 74 years old answered the sun exposure module of the National Health Examination Survey questionnaire, which was performed in 2015. Hazardous sun exposure and sun protective behaviours were assessed for a typical summer day during leisure time. Descriptive statistics and Poisson regression were used to examine associations between hazardous sun exposure and adherence to sun protective behaviours with population characteristics. Among the 4,797 participants, prevalence of hazardous sun exposure was 76.4 and 67.4% among men and women, respectively. It was mainly associated with younger age, lower education level and practice of regular physical activity. The prevalence of nonadherence to sun protective behaviours was 38.6 and 22.3%, among men and women, respectively. Education and income were inversely associated with adherence to sun protective behaviours. Individuals residing in regions displaying higher UV indexes had higher prevalence of sun protective practices. The prevalence of hazardous sun exposure and nonadherence to sun protective behaviours is considerable in the Portuguese population. The association between these indicators and sociodemographic factors in the population, reinforces the importance of developing sun protection messages directed at specific target audiences.

Purpose The purpose of this paper is to examine, through a qualitative lens, how community elder abuse and the ageing process are represented in the older adults’ narratives reporting abuse perpetrated by family members. Design/methodology/approach A qualitative study of a convenience sample of 22 interviews from 24 older adults (two couples) aged 60 years or older who had experienced one or more types of abuse and had sought help about the victimisation experience. A general inductive approach of thematic content analysis was employed. Findings The four main emergent themes related to the passage of time or the perception of becoming old within the process of abuse were: abuse grown old, abuse after entering later life, vulnerability to abuse and responses to abuse. Ageing was found to be associated with an increase vulnerability to abuse and an important element in shaping how older adults experience, report and cope with victimization. The social and contextual issues of being older also influenced the decision of ending (or not) the abuse and the victims’ repertoire of responses. Originality/value Despite the little suitability of chronological age to define and delimit elder abuse, understanding the phenomenon demands the recognition of ageing (both as a process and as a product) in order to more accurately identify aetiology processes and develop interventions.

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31014265/ Background: Research on elder abuse has defined it as a multidimensional construct that encompasses a set of different abusive behaviours, victims, perpetrators and settings. The array of possible elder abuse configurations is difficult to capture. This study sought to identify victimization patterns that represent distinct elder abuse configurations based on specific abusive behaviours and on the relationship with the perpetrator; it also sought to determine the association between these latent classes with victims' characteristics. Method: Data comes from two elder abuse surveys: a representative sample of community-dwelling adults and a convenience sample of older adults reporting elder abuse to four state and NGOs institutions. Latent Class Analysis (LCA) was used to categorize victimization in the population-based (N = 245) and in the victims' sample (N = 510) using 7 items measuring physical, psychological and financial abuse, and appointed perpetrators. Association tests were conducted to determine differences and similarities of victims' characteristics between the different obtained classes. Results: The LCA procedure identified six different latent classes of victimization experiences in each of the samples, which were statistically and plausibly distinct. In the population-based survey: verbal abuse by others (29%); psychological abuse from children/grandchildren (18%); overlooked by others (18%); stolen by others (15%); verbal Intimate Partner Violence (IPV) (14%) and physical and psychological IPV (6%). In the victims' survey: physical abuse by children/grandchildren (29%); physical IPV (26%); psychological abuse by children/grandchildren (18%); polyvictimization by others (16%); physical abuse by others (6%) and physical and psychological IPV (4%). In the victims survey the 6 groups significantly differ in age, gender, civil status, living arrangements, perceived social support and functional status. Conclusions: The results support the possibility of the multidimensionality of elder abuse not being accounted by the "classical" abuse typologies. Elder abuse victims seeking help may represent a distinct group from that included in population-based prevalence studies. The appointed perpetrators may be the most meaningful and relevant aspect in distinguishing victimization experiences. Further research is needed to develop tailored interventions to specific elder abuse cases and enhance successful outcomes. The present study did not received any funding, but employed a subset of the dataset of the Ageing and Violence project. This project was conducted by the Epidemiology Department of the National Health Institute Doutor Ricardo Jorge and was funded by the Foundation for Science and Technology (Fundação para a Ciência e Tecnologia) in Portugal (grant PTDC/CS-SOC/110311/2009). info:eu-repo/semantics/publishedVersion

Lean Thinkingaligned with Information technology can promote competitiveness for modern enterprises, while improve the performance of technological activities and eliminate no value-added tasks to the design process of product. The paper is a contextualization of the current wastes evidenced during the research work carried out in a company that supplies electronic components to automotive industry. Workshops were developed to map the wastes in the sample production processes, as all interested parties are seeing, discussing and learning together in a freely-open environment. The workshops promoted the identification of 60 types of waste, and 26 roots cause. In order to solve scientifically the root causes problems, the production procedures will be readjusted by adopting production guidelines according to the principles of Lean, and some digitization measures will also be considered. The evidence from the workshops demonstrates that the main types of waste reported in the present literature can also be observed in complex projects., This work is supported by: European Structural and Investment Funds in the FEDER component, through the Operational Competitiveness and Internationalization Programme (COMPETE 2020) [Project nº 039479; Funding Reference: POCI-01-0247- FEDER- 039479].

BACKGROUND Limited research evidence exists on the development of web-based platforms for reciprocal communication, coproduction research, and dissemination of information among parents, professionals, and researchers. This paper provides learning and the outcomes of setting up a bespoke web-based platform using social media. OBJECTIVE This study aims to explore the establishment of a web-based, multicontextual research communication platform for parents and stakeholders of children with congenital anomalies using social media and to identify associated research and ethical and technical challenges. METHODS The ConnectEpeople e-forum was developed using social media platforms with a stakeholder engagement process. A multilevel approach was implemented for reciprocal engagement between parents of children with congenital anomalies, researchers, health care professionals, and other stakeholders using private and invisible and public Facebook groups, closed Twitter groups, and YouTube. Ethical approval was obtained from Ulster University. RESULTS Nonprofit organizations (N=128) were invited to engage with an initial response rate of 16.4% (21/128). Of the 105 parents contacted, 32 entered the private and invisible Facebook groups to participate in the coproduction research. Public Facebook page followers rose to 215, a total of 22 posts had an engagement of >10%, and 34 posts had a reach of over 100. Webinars included requested information on childhood milestones and behavior. YouTube coverage included 106 ConnectEpeople videos with 28,708 impressions. Project information was obtained from 35 countries. The highest Facebook activity occurred during the early morning hours. Achievement of these results required dedicated time management, social media expertise, creativity, and sharing knowledge to curate valuable content. CONCLUSIONS Building and maintaining a multilayered online forum for coproduction and information sharing is challenging. Technical considerations include understanding the functionality and versatility of social media metrics. Social media offers valuable, easily accessible, quantitative, and qualitative data that can drive the reciprocal process of forum development. The identification and integration of the needs of the ConnectEpeople e-forum was a key driver in the dissemination of useful, meaningful, and accessible information. The necessary dedicated administration to respond to requests and posts and collate data required significant time and effort. Participant safety, the development of trust, and the maintenance of confidentiality were major ethical considerations. Discussions on social media platforms enabled parents to support each other and their children. Social media platforms are particularly useful in identifying common family needs related to early childhood development. This research approach was challenging but resulted in valuable outputs requiring further application and testing. This may be of particular importance in response to COVID-19 or future pandemics. Incorporating flexible, adaptable social media strategies into research projects is recommended to develop effective platforms for collaborative and impactful research and dissemination. CLINICALTRIAL

The metabolic syndrome consists of a set of factors that, when associated, are associated with a higher risk of developing cardiovascular diseases and type 2 diabetes, and is thus an important public health problem. The objective of this study was to estimate the prevalence of this syndrome in the Portuguese population, and to evaluate possible associations with demographic and socioeconomic determinants.Based on the 1st National Health Survey with Physical Examination of 2015, a cross-sectional epidemiological study was conducted on a representative sample of the Portuguese population (n = 4797) aged between 25 and 74 years old. The prevalence was estimated for the total population and each gender, stratified by age group, health region, type of urban area, marital status, education, professional status, and risk of poverty. The magnitude of the associations was measured with adjusted prevalence ratios.In the Portuguese population the estimated prevalence was 33.4% [95% CI, 31.7 - 35.1] [35.6% in men (95% CI, 31.9 - 39.2) and 31.3% in women (95% CI, 28.5 - 34.2)]. In both genders, the highest prevalence was significantly associated with increasing age, widowed/married/de facto partners and those with lower levels of education. There was no association with gender, health region, type of urban area, professional status or risk of poverty.This syndrome was present in a third of the Portuguese population. The knowledge of its epidemiology enables the identification of population groups with higher cardiovascular and metabolic risk.Metabolic syndrome was independently associated with specific groups. This knowledge reinforces the importance of a holistic assessment of the health determinants associated with the metabolic syndrome.Introdução: A síndrome metabólica consiste num conjunto de fatores que, quando associados, conferem maior risco de desenvolver doenças cardiovasculares e diabetes tipo 2, constituindo um importante problema de saúde pública. O objetivo deste estudo foi estimar a prevalência desta síndrome na população portuguesa, e avaliar possíveis associações com determinantes demográficos e socioeconómicos. Material e Métodos: Com base no primeiro Inquérito Nacional de Saúde com Exame Físico de 2015, realizou-se um estudo epidemiológico transversal numa amostra representativa da população portuguesa (n = 4797) entre os 25 e 74 anos. A prevalência foi estimada na população total e em cada sexo, estratificada por grupo etário, região de saúde, tipologia de área urbana, estado civil, escolaridade, situação profissional e risco de pobreza. A magnitude das associações foi medida pelas razões de prevalências ajustadas. Resultados: A prevalência estimada foi de 33,4% (IC 95%, 31,7 – 35,1) na população portuguesa [35,6% nos homens (IC 95%, 31,9 – 39,2) e 31,3% nas mulheres (IC 95%, 28,5 – 34,2)]. Em ambos os sexos, a maior prevalência estava significativamente associada ao aumento da idade, a indivíduos viúvos/casados/unidos de facto e com menor escolaridade. Não se verificou associação com sexo, região de saúde, tipologia de área urbana, situação profissional ou risco de pobreza.Discussão: Esta síndrome estava presente num terço da população portuguesa. O conhecimento da sua epidemiologia permite identificar grupos populacionais com maior risco cardiovascular e metabólico. Conclusão: A síndrome metabólica estava independentemente associada a grupos específicos. Este conhecimento reforça a importância de uma avaliação holística dos determinantes de saúde associados à síndrome metabólica.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease that is becoming a significant global health care problem. Several studies have shown that people with diabetes are more susceptible to oral problems, such as periodontitis and, although the causes are still inconclusive, the oral microbiota seems to be an important factor in this interaction. This study aimed to characterize the oral microbiome of a sample representing T2DM patients from Portugal and exploit potential associations between some microorganisms and variables like teeth brushing, smoking habits, and nutrient intake. By sequencing the hypervariable regions V3-V4 of the 16S rRNA gene in 50 individuals belonging to a group of diabetes patients and a control group, we found a total of 233 taxa, from which only 65% were shared between both groups. No differences were found in terms of alpha and beta diversity between groups or habits categories. Also, there were no significant differences in the oral microbiome profiles of control and diabetes patients. Only the class Synergistia and the genus TG5, which are related to periodontitis, were statistically more frequent in the control group. This finding can be justified by the fact that these diabetic patients usually have their oral health under close medical control than an average healthy person, which in this study was represented by the control group.IMPORTANCEDiabetes has become a significant global health care issue as its incidence continues to increase exponentially, with type 2 diabetes being responsible for more than 90% of these cases. Portugal is one of the countries with a higher prevalence of diabetes in Europe. It has been reported that diabetic people have an increased risk of developing several health problems such as oral infections mostly caused by opportunistic pathogens. Some studies have pointed out a relationship between diabetes and oral microbiome. Therefore, the characterization of the microbial ecosystem of the mouth in reference groups is crucial to provide information to tackle oral health pathogen-borne conditions. In this study, we provide the first characterization of the oral microbiome of type 2 diabetes mellitus patients from Portugal, and therefore, contributing new data and knowledge to elucidate the relationship between diabetes and the oral microbiome.

ObjectiveDignity therapy (DT) is well established in adult populations, and it is likely that it could benefit younger people. This study aimed to adapt the adult Portuguese DT question framework for adolescents (DT-QF-Adol) (ages 10–18).MethodFive stages were followed: (1) the Portuguese DT-QF for adults was adapted for adolescents with the original author's collaboration, (2) an expert committee provided feedback on the adapted version, (3) an initial consensus version of the DT-QF-Adol was created, (4) expert committee consult affirmed final consensus, and (5) validation stage with a sample of 17 adolescents followed in ambulatory psychology clinic.ResultsDT's original author endorsed the final Portuguese DT-QF-Adol, reinforcing that it captures the fundamental dimensions of DT. There was 100% agreement on the final consensus version and defined age group (10–18 years old). Twenty adolescents were invited to participate, and 17 were included after informed consent was obtained; 53% were female. The average age was 12.7 years. The interviewed adolescents reported that the DT-QF-Adol was clear, and they did not identify any ambiguity or difficulty in answering any of the questions. They assumed that this information could positively affect the way parents and friends see and cared for them, permitting others to understand their concerns and preferences. Participants felt that the DT-QF-Adol could be a good starting point for a conversation with their loved ones. Although they did not consider vital for health professionals to access their answers, they strongly felt that the DT-QF-Adol might be essential to sick adolescents and they would recommend it to others.Significance of resultsWe developed a DT-QF of nine questions for Portuguese adolescents (DT-QF-Adol), coined Protocolo de Perguntas da Terapia da Dignidade para Adolescentes — 10–18 anos. This tool can potentially be considered a good addition for pediatric palliative care.

Background Heatwaves can lead to increased mortality. In the Portuguese heat–health warning system (HHWS), ÍCARO, a daily report with heat-related mortality prediction is sent to heat–health action plan (HHAP) practitioners. HHAP practitioners assess risk and implement measures to prevent heatwave-related impact, but ÍCARO’s use and understanding are unknown. We assessed ÍCARO’s use and understanding by key HHAP practitioners. Methods We conducted semi-structured interviews with national/regional HHAP practitioners. Interviews were recorded, transcribed and analysed using thematic content analysis. To maximize credibility a validation process was implemented through researcher triangulation; a sample of 30 segments was recorded by independent researchers. Results We conducted six interviews with nine professionals (mean time 52 min) from five regions. We identified four categories: report’s content and presentation, report’s reception and communication, ÍCARO and risk assessment and other issues. Practitioners use ÍCARO and perceived it as relevant; they raised issues on its interpretation and felt these were not fully addressed, given researchers’ use of statistical/epidemiological terms. We identified the need for improved communication and report’s clarity. Conclusions Our study stresses the need for collaboration between experts within HHWS/HHAP. Despite ÍCARO’s understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO’s interpretation. Practitioners’ needs should be considered when developing/revising tools.

Background Using social media for research purposes is novel and challenging in terms of recruitment, participant knowledge about the research process, and ethical issues. This paper provides insight into the recruitment of European parents of children with specific congenital anomalies to engage in coproduction research by using social media. Secret Facebook groups, providing optimal security, were set up for newly recruited research-aware parents (RAPs) to communicate privately and confidentially with each other and for the research team to generate questions and to interpret findings. Objective This study aimed to use social media for the recruitment and engagement of parents in research and to determine the research priorities of parents who have children with Down syndrome, cleft lip with or without cleft palate, congenital heart defects, and spina bifida. Methods The design was exploratory and descriptive with 3 phases. Phase 1 included the recruitment of RAPs and generation of research questions important to them; phase 2 was a Web-based survey, designed using Qualtrics software, and phase 3 included analysis and ranking of the top 10 research questions using an adapted James Lind Alliance approach. Simple descriptive statistics were used for analysis, and ethical approval was obtained from the Ethics Filter Committee of the Institute of Nursing and Health Research, Ulster University. Results The recruitment of 32 RAPs was a sensitive process, varying in the time taken to consent (mean 51 days). However, parents valued the screening approach using the State-Trait Anxiety Inventory as a measure to ensure their well-being (mean 32.5). In phase 1, RAPs generated 98 research questions. In phase 2, 251 respondents accessed the Web-based survey, 248 consented, and 80 completed the survey, giving a completeness rate of 32.3% (80/248). Most parents used social media (74/80, 92%). Social media, online forums, and meeting in person were ranked the most preferable methods for communication with support groups networks and charities. Most respondents stated that they had a good understanding of research reports (71/80, 89%) and statistics (68/80, 85%) and could differentiate among the different types of research methodologies (62/80, 78%). Phase 3 demonstrated consensus among RAPs and survey respondents, with a need to know the facts about their child’s condition, future health, and psychosocial and educational outcomes for children with similar issues. Conclusions Social media is a valuable facilitator in the coproduction of research between parents and researchers. From a theoretical perspective, ocularcentrism can be an applicable frame of reference for understanding how people favor visual contact.

Background Heatwaves can lead to increased mortality. Portugal has a Heat-Health Warning System (HHWS) in place (ÍCARO system). Researchers at the Instituto Ricardo Jorge send a daily report with heat-related mortality forecasts to key stakeholders (e.g. Heat-Health Action Plans (HHAP) staff). HHAP practitioners issue warnings and implement measures to prevent heatwaves-related mortality. ICARO is amongst the recommended data sources to assess risk and issue warnings but its use and understanding is unknown. Therefore, we aimed to assess ÍCARO’s use and understanding by key HHAP practitioners. Methods We conducted semi-structured interviews with national and regional HHAP practitioners. Interviews were recorded, transcribed, and analysed using thematic content analysis. Intercoder reliability was applied to a sample of segments from 5 of 6 interviews. Results We conducted 6 interviews with 9 professionals (mean time 52 minutes). We identified 4 categories: Report’s content and presentation, Report’s reception and communication, ÍCARO and risk assessment, Other issues. Practitioners use ÍCARO and perceived it as very relevant tool. However, they mentioned several questions on its interpretation. Practitioners also felt their questions were not fully answered, given researchers’ use of statistical terms. Finally, practitioners referred the need to assess risk at the local level, information not currently provided. We also identified the need for improved communication and report’s clarity. Conclusions Our study stresses the need for an integrated collaboration between experts within HHWS and HHAP. Despite ICARO’s understanding being challenging, practitioners consider it a relevant tool. Researchers should use less statistical language and clarify ÍCARO interpretation. Practitioners’ needs should be considered when developing or revising tools. We are currently implementing some of these recommendations in an attempt to close the gap between researchers and practitioners. Key messages Portuguese Heat–Health Action Plans practitioners use heat-related mortality forecasts (ICARO) and perceived it as very relevant instrument. However there find ICARO’s interpretation challenging. Portuguese Heat/Health Action Plans Practitioners’ needs should be considered when revising or developing tools, and notes should be added to clarify statistical/technical concepts.

Aims: Diabetes Mellitus is a major public health threat worldwide and continues to increase in numbers and significance. Estimates of diabetes prevalence, awareness, treatment and control are essential to effectively monitor its trends, plan and evaluate interventions. Methods: We conducted a nationwide health examination survey in the population residing in Portugal aged between 25 and 74 years old in 2015. It consisted in a cross sectional prevalence study which included the measurement of HbA1c, a physical examination and a general health interview of a probabilistic sample of 4911 individuals (Authorization n°9348/2010 of the National Committee for Data Protection). Results: The overall prevalence of diabetes was 9.9% (95%CI: 8.4; 11.5). It was higher in males than in females (12.1% vs 7.8%). Diabetes was more prevalent among individuals of lower education and without any professional activity. The majority of persons with diabetes was aware of their condition (87.1%) and was taking antidiabetic medication (79.7%). Of these, 63.2% had glycated hemoglobin levels lower than 7.0% (53 mmol/mol), but the majority failed to comply with the LDL and blood pressure recommended clinical targets (71.9% and 59.0%). Similarly, the prevalence of prediabetes was 16%, higher among women than men (17.5% vs 14.4%). Conclusion: The prevalence of diabetes and prediabetes remains higher than the global and European estimates, although there is increasing awareness of this disorder. Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation (PDP000039 - Public Health Initiatives Program - EEA Grants) info:eu-repo/semantics/publishedVersion

Purpose Psychological elder abuse (PEA) assessment is described with different thresholds. The purpose of this paper is to examine how the prevalence of PEA and the phenomenon’s characterisation varied using two different thresholds. Design/methodology/approach Participants from the cross-sectional population-based study, Aging and Violence (n=1,123), answered three questions regarding PEA. The less strict measure considered PEA as a positive response to any of the three evaluated behaviours. The stricter measure comprised the occurrence, for more than ten times, of one or more behaviours. A multinomial regression compared cases from the two measures with non-victims. Findings Results show different prevalence rates and identified perpetrators. The two most prevalent behaviours (ignoring/refusing to speak and verbal aggression) occurred more frequently (>10 times). Prevalence nearly tripled for “threatening” from the stricter measure (>10 times) to the less strict (one to ten times). More similarities, rather than differences, were found between cases of the two measures. The cohabiting variable differentiated the PEA cases from the two measures; victims reporting abuse >10 times were more likely to be living with a spouse or with a spouse and children. Research limitations/implications Development of a valid and reliable measure for PEA that includes different ranges is needed. Originality/value The study exemplifies how operational definitions can impact empirical evidence and the need for researchers to analyse the effect of the definitional criteria on their outcomes, since dichotomization between victim and non-victim affects the phenomenon characterisation.

Depression and depressive symptoms have been studied both as risk factors and consequences of elder abuse, even though the most common cross-sectional design of the studies does not allow inferring cause or consequence relationships. This study estimates the proportion of older adults who screened positive for depressive symptoms among those self-reporting elder abuse and examines whether individual characteristics and/or abusive experience aspects are associated with self-reported depressive symptoms. Participants were 510 older adults self-reporting experiences of abuse in family setting enrolled in the cross-sectional victims’ survey of the Aging and Violence Study. Depressive symptoms were assessed through the abbreviated version of the Geriatric Depression Scale (GDS-5). Poisson regression was used to determine the prevalence ratio (PR) of screening depressive symptoms according to individual and abusive experience covariates: sex, age group, cohabitation, perceived social support, chronic diseases, functional status, violence type, perpetrator, and number of conducts. Women (PR = 1.18, 95% confidence interval [CI] = [1.04, 1.35]) individuals perceiving low social support level (PR = 1.36, 95% CI = [1.16, 1.60]) and with long-term illness (PR = 1.17, 95% CI = [1.02, 1.33]) were found to be associated with increased risk for screening depressive symptoms. In regard to abusive experience, only the number of abusive conducts increased the PR (PR = 1.07, 95% CI = [1.05, 1.09]). Routine screening for elder abuse should include psychological well-being assessment. Interventions toward risk alleviation for both mental health problems and elder abuse should target women perceiving low social support level and with long-term illness. info:eu-repo/semantics/publishedVersion

BACKGROUND Using social media for research purposes is novel and challenging in terms of recruitment, participant knowledge about the research process, and ethical issues. This paper provides insight into the recruitment of European parents of children with specific congenital anomalies to engage in coproduction research by using social media. Secret Facebook groups, providing optimal security, were set up for newly recruited research-aware parents (RAPs) to communicate privately and confidentially with each other and for the research team to generate questions and to interpret findings. OBJECTIVE This study aimed to use social media for the recruitment and engagement of parents in research and to determine the research priorities of parents who have children with Down syndrome, cleft lip with or without cleft palate, congenital heart defects, and spina bifida. METHODS The design was exploratory and descriptive with 3 phases. Phase 1 included the recruitment of RAPs and generation of research questions important to them; phase 2 was a Web-based survey, designed using Qualtrics software, and phase 3 included analysis and ranking of the top 10 research questions using an adapted James Lind Alliance approach. Simple descriptive statistics were used for analysis, and ethical approval was obtained from the Ethics Filter Committee of the Institute of Nursing and Health Research, Ulster University. RESULTS The recruitment of 32 RAPs was a sensitive process, varying in the time taken to consent (mean 51 days). However, parents valued the screening approach using the State-Trait Anxiety Inventory as a measure to ensure their well-being (mean 32.5). In phase 1, RAPs generated 98 research questions. In phase 2, 251 respondents accessed the Web-based survey, 248 consented, and 80 completed the survey, giving a completeness rate of 32.3% (80/248). Most parents used social media (74/80, 92%). Social media, online forums, and meeting in person were ranked the most preferable methods for communication with support groups networks and charities. Most respondents stated that they had a good understanding of research reports (71/80, 89%) and statistics (68/80, 85%) and could differentiate among the different types of research methodologies (62/80, 78%). Phase 3 demonstrated consensus among RAPs and survey respondents, with a need to know the facts about their child’s condition, future health, and psychosocial and educational outcomes for children with similar issues. CONCLUSIONS Social media is a valuable facilitator in the coproduction of research between parents and researchers. From a theoretical perspective, ocularcentrism can be an applicable frame of reference for understanding how people favor visual contact.

As propriedades psicométricas da versão reduzida (5 itens) da Escala de Depressão Geriátrica (GDS), instrumento de avaliação da depressão junto de pessoas idosas, foram examinadas em duas amostras de pessoas com 60 e mais anos. A validade concorrente, a especificidade e a sensibilidade foram obtidas contra o Inventário de Depressão do Beck (IDB-II) numa amostra de 66 indivíduos (média das idades de 70 anos), enquanto a validade da estrutura fatorial foi observada numa amostra de base populacional de 1023 indivíduos (média das idades de 71 anos). A versão de 5 itens da Escala de Depressão Geriátrica apresenta valores de consistência interna e de correlação com o IDB-II que sugere a sua fiabilidade e valores de sensibilidade e especificidade adequados ao rastreamento de sintomatologia depressiva na população idosa. Os resultados obtidos pela Análise Fatorial Confirmatória (AFC) sugerem que o modelo unifactorial não apresenta as características desejadas, indicando que um dos itens (item 4) poderá ter um menor poder discriminativo, pelo que se observa um melhor ajustamento no modelo obtido pela AFC para 4 itens. The validity of the short Geriatric Depression Scale (GDS) version (5 items) was assessed in two samples of older adults aged 60 or more years. Concurrent validity, specificity, and sensitivity were obtained in a convenience sample of 66 individuals (mean of 70 years) by comparison to the Beck Depression Inventory (IDB-II). Factorial analysis was conducted in a population-based sample of 1023 participants (mean of 71 years). The 5-item version of the Geriatric Depression Scale presented adequate internal consistency values and good correlation results with the IDB-II. These results suggest its reliability and adequate sensitivity, and specificity values for screening for depressive symptoms in the elderly population. The results obtained by the Confirmatory Factor Analysis (CFA) suggest that the one-factor model does not have the desired characteristics – one of the items (item 4) may have a lower discriminative power and a better fit in the model obtained by the CFA for 4 items was observed. info:eu-repo/semantics/publishedVersion

This paper presents an aligned carbon nanotube (CNT)-based strain sensor. Vertical aligned carbon nanotubes (VA-CNT), synthesized by chemical vapour deposition (CVD), were knocked down onto polymeric films, in order to obtain a thin 10 × 10 × 0.05 mm CNT patch. Different polymeric substrates, ADEXepoxy, polyethylene terephthalate (PET) and polyimide (PI) were used. The samples’ morphology before and after the knock down process, specifically their alignment, was observed by scanning electron microscopy (SEM). The good quality of the synthesized VA-CNT was assessed by Raman spectroscopy. Furthermore, transmission electron microscopy (TEM) analysis was carried out to determine the average wall number and diameters (inner and outer) of the VA-CNT. A MATLAB software with an adapted Van der Pauw method for anisotropic conductors was developed to determine the electric properties of the obtained samples, which were strained in the transverse (X) and parallel (Y) directions with respect to the CNT alignment. The electric anisotropy, defined as electric resistance ratio between obtained measurements along the X (Rxx) and Y (Ryy) -axes, decreases with deformation increment when the sample was strained in the Y-direction, while it increases when strained in the X-direction. Moreover, the obtained Gauge factor values showed a much sensitive response to deformation, i.e., approximately 47% increase in GF values, when the samples are strained transversely to CNT alignment. These results showed that the piezoresistive CNT/polymeric based sensor produced is suitable for strain sensing applications., This work was funded under the project "IAMAT -Introduction of advanced materials technologies into new product development for the mobility industries", with reference MITP-TB/PFM/0005/2013, under the MIT-Portugal program exclusively financed by FCT - Fundacao para a Ciencia e Tecnologia. This work was carried out in part using the Advanced Electron Microscopy, Imaging and Spectroscopy Facility (TEM) of INL - Iberian Nanotechonology Laboratory.

INTRODUCTION: Oral health is a determinant for quality of life and preventive behaviours such as regular tooth brushing can reduce the risk of a wide spectrum of oral diseases. Adopting preventive behaviours increases the likelihood of being healthy and can be conditioned by demographic and socio-economic factors. OBJECTIVE: This study aims to describe preventive oral hygiene behaviours in the Portuguese population and assess their association with sociodemographic and socioeconomic factors. MATERIAL AND METHODS: A cross-sectional epidemiologic study was developed using data from the first Portuguese National Health Examination Survey. The target population comprised Portuguese community-dwelling residents aged between 25 and 74 years old. The percentage of individuals who brushed their teeth at least twice a day, provided that once was before sleeping, was considered the indicator showing a preventive behaviour, as this is recommended by the General Directorate of Health in Portugal. Poisson regression was used to identify factors independently associated with this behaviour. RESULTS: Sixty-five per cent of the participants reported tooth brushing as recommended. The prevalence of adoption of this preventive behaviour was higher among those living in urban areas and those who have higher educational level. Results show an association between being male and having low educational level with lesser adoption of preventive oral health behaviours. CONCLUSION: These findings suggest a need for integrated approaches, from measures tackling social inequalities to actions focused on improving health literacy. It is also important to expand dental healthcare services and improve effective coverage to increase access for rural population. INSEF was developed as part of the Pre-defined project of the Public Health Initiatives Program, entitled ‘Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health and bilateral cooperation’, that benefited from a 1,500,000€ grant from Iceland, Liechtenstein and Norway through the EEA Grants. info:eu-repo/semantics/publishedVersion

Background: This study aimed to compare self-reported and examination-based prevalence of hypertension and hypercholesterolemia in Portugal in 2015 and to identify factors associated with the measurement error in self-reports. Methods: We used data from the Portuguese National Health Examination Survey (n = 4911), that combines personal interview, blood collection and, physical examination. Sensitivity and specificity of self-reported hypertension and hypercholesterolemia were calculated. Poisson regression was used to estimate prevalence ratios (PRs) of underreport of hypertension and hypercholesterolemia according to sex, age, socioeconomic status (education and income) and general practitioner (GP) consultation in the past year. Results: Sensitivity of self-reports was 69.8% for hypertension and 38.2% for hypercholesterolemia. Underreport of hypertension was associated with male gender (PR = 1.54), lack of GP consultation (PR = 1.70) and being 25–44 years old (PR = 2.45) or 45–54 years old (PR = 2.37). Underreport of hypercholesterolemia was associated with lack of GP consultation (PR = 1.15), younger age (PR = 1.83 for 25–44 age group and PR = 1.52 for 45–54 age group), secondary (PR = 1.30) and higher (PR = 1.27) education. Conclusion: Self-reported data underestimate prevalence of hypertension and hypercholesterolemia. Magnitude of measurement error in self-reports varies by health conditions and population characteristics. Adding objective measurements to self-reported questionnaires improve data accuracy allowing better understanding of socioeconomic inequalities in health. O primeiro Inquérito Nacional de Saúde com Exame Físico foi desenvolvido como parte integrante do projeto “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation”, que beneficiou de um apoio financeiro de 1.500.000€ concedido pela Islândia, Liechtenstein e Noruega, através do Programa Iniciativas em Saúde Pública (PT06) financiado pelas EEA Grants 2009-2014. info:eu-repo/semantics/publishedVersion