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Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01–1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29–3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

The limpet Patella aspera is an endemic species to the Macaronesian Islands. Its high economic value and vulnerability to exploitation has triggered the interest in the development of its aquaculture. Significant progress has been made in recent years, with the establishment of artificial fertilization and larval production protocols. However, there are at least two major challenges that need to be addressed before a commercial production can be achieved: larval settlement and juvenile grow-out. The aim of this research was to study the effect of different algae substrates (Ulvella lens, Amphora sp., Entomoneis sp., Navicula salinicola and Nitzschia sp.) on P. aspera settlement and to test the effect of two diets on juvenile growth: a mono diet based on U. lens versus a mixed diet composed by U. lens and the diatoms Nitzschia sp. and Navicula salinicola. Results showed that U. lens was the most efficient settlement cue, given that 84.6% of the post-larvae obtained were found on this algae substrate. In the following trial, U. lens was selected as the base diet for the grow-out phase. The rearing system used ensured juvenile survival percentages above 80%. The regular supply of the diatom mixture, as a dietary supplement, significantly enhanced juvenile growth performance. After 220 days post fertilization, limpets that grew on the mixed diet (U. lens plus diatoms) presented an average shell length of 19.280 ± 5.296 mm. Additionally, developed gonads were observed in females with less than 8 months. This study presents the first record of P. aspera juvenile grow-out, born from artificial fertilization, which represents a major step toward the development of limpet aquaculture.

Abstract The growing interest in microRNAs (miRNAs) over recent years has led to their characterization in numerous organisms. However, there is currently a lack of data available on miRNAs from triatomine bugs (Reduviidae: Triatominae), which are the vectors of the protozoan parasite Trypanosoma cruzi, the causative agent of Chagas disease. A comprehensive understanding of the molecular biology of vectors provides new insights into insect-host interactions and insect control approaches, which are key methods to prevent disease incidence in endemic areas. In this work, we describe the miRNome profiles from gut, hemolymph, and salivary gland tissues of the Rhodnius prolixus triatomine. Small RNA sequencing data revealed abundant expression of miRNAs, along with tRNA- and rRNA-derived fragments. Fifty-two mature miRNAs, previously reported in Ecdysozoa, were identified, including 39 ubiquitously expressed in the three tissues. Additionally, 112, 73, and 78 novel miRNAs were predicted in the gut, hemolymph, and salivary glands, respectively. In silico prediction showed that the top eight most highly expressed miRNAs from salivary glands potentially target human blood-expressed genes, suggesting that R. prolixus may modulate the host’s gene expression at the bite site. This study provides the first characterization of miRNAs in a Triatominae species, shedding light on the role of these crucial regulatory molecules.

Nitric oxide (•NO), a diffusible free radical, is an intercellular messenger, playing a crucial role in several key brain physiological processes, including in neurovascular coupling (NVC). In the brain, glutamatergic activation of the neuronal nitric oxide synthase (nNOS) enzyme constitutes its main synthesis pathway. However, when oxygen (O2) supply is compromised, such as in stroke, ischemia, and aging, such •NO production pathway may be seriously impaired. In this context, evidence suggests that, as already observed in the gastric compartment, the reduction of nitrite by dietary compounds (such as ascorbate and polyphenols) or by specific enzymes may occur in the brain, constituting an important rescuing or complementary mechanism of •NO production. Here, using microsensors selective for •NO, we show that nitrite enhanced the •NO production in a concentration-dependent manner and in the presence of ascorbate evoked by N-methyl-D-aspartate (NMDA) and glutamate stimulation of rat hippocampal slices. Additionally, nitrite potentiated the •NO production induced by oxygen-glucose deprivation (OGD). Overall, these observations support the notion of a redox interaction of ascorbate with nitrite yielding •NO upon neuronal glutamatergic activation and given the critical role of NO as the direct mediator of neurovascular coupling may represents a key physiological mechanism by which •NO production for cerebral blood flow (CBF) responses to neuronal activation is sustained under hypoxic/acidic conditions in the brain.

Introdução: A Enfermagem Familiar é fundamental na colaboração com as famílias em todas as fases da vida, de forma a maximizar a saúde e o bem-estar. O MDAIF emerge para responder às necessidades dos profissionais de saúde relativamente aos cuidados com as famílias (Figueiredo, 2012). Objetivo: Caracterizar a família de acordo com o MDAIF e identificar as necessidades em saúde da família. Métodos: Estudo descritivo, de natureza qualitativa. Para a colheita de dados foi realizada uma entrevista estruturada, com base no MDAIF, a uma família nuclear constituída pelo casal e dois filhos. A participação foi voluntária e assinado consentimento informado. Resultados: Família de classe social média-alta, ligada e flexível, equilibrada e com perceção de ser altamente funcional, mas com 80% de probabilidade de desenvolver patologias psicossomáticas. Conclusão: A família é o centro dos cuidados da Enfermagem Familiar e neste sentido o enfermeiro deve conhecer as necessidades e os problemas das famílias de modo a adequar as suas intervenções. O modelo utilizado veio facilitar o reconhecimento destas necessidades e problemas melhorando a prestação de cuidados.

Abstract Introduction The diagnosis of latent tuberculosis infection (LTBI) relies largely on the tuberculin skin test (TST) or, more recently, on interferon‐gamma release assays (IGRA). Knowledge regarding these tests is essential to improve their usefulness in combating the tuberculosis epidemic. Objectives To characterize the agreement between the IGRA and TST tests by determining the kappa coefficient (K) and agreement rate between these two tests in patients with active tuberculosis (TB). Methods Retrospective cohort study conducted with data from active TB patients notified in the Portuguese Tuberculosis Surveillance System (SVIG‐TB), from 2008 to 2015. TST results were interpreted using a 5 mm (TST‐5 mm) and 10 mm (TST‐10 mm) cutoff. Kappa coefficient and agreement rate were calculated in order to evaluate the agreement between IGRA and TST (both cutoffs) test results. Results A total of 727 patients with results for both tests were included in the study, of which 3.4% (n = 25) had HIV infection, 5.6% (n = 41) diabetes, 5.0% (n = 36) oncological diseases and 4.4% (n = 32) inflammatory diseases. Of the 727 patients, 16.5% (n = 120) presented different outcomes between IGRA and TST‐5 mm, and 20.5% (n = 149) presented different outcomes between IGRA and TST‐10 mm. Kappa coefficient between IGRA and TST‐5 mm was 0.402 (p

Abstract Background Tuberculosis (TB) diagnosis and treatment delays increase the period of infectiousness, making TB control difficult and increasing the fatality rates. This study aimed to determine the evolution of health care service delay (time between the patient’s first contact with the health service and the diagnosis/start of treatment) and patient delay (time between onset symptoms date and the date of first contact with health services) for Pulmonary Tuberculosis (PTB) in Portugal between 2008 and 2017 across different regions, age groups and gender. Methods An exploratory analysis was performed, trends of both delays were studied, and 36 months forecasts were generated. We used the permutation test to test differences between groups and the Seasonal and Trend decomposition using Loess (STL) method and Autoregressive Integrated Moving Average (ARIMA) models for forecasting for both Health and Patient delays. We used data from notified PTB cases in mainland Portugal between 2008 and 2017, provided by the national surveillance system. Results Health delays remained relatively constant while patient delays increased. Females had significantly higher health delays in some regions. Individuals older than 64 had higher health delays than younger individuals, while patient delay for working-age individuals between 15 and 64 years old, presents higher patient delay. Conclusions Forecasts presage that the upward trend of the delays is unlikely to fall in the coming years. It is important to understand the evolution of the delays and predict how these will evolve. Our understanding of the delays behaviours will contribute to better health policies and resources allocation.

Background: The COVID-19 pandemic may affect youth’s physical and mental well-being, partially because of the countries’ rules to contain the virus from spreading. However, there is still uncertainty about the impact of physical distancing on youth’s mental health. We aimed to estimate the prevalence of feeling agitated, anxious, down, sad, or low mood (FNF) due to physical distance measures and verify which factors are associated with young Portuguese and Brazilian people. Methods: We used cross-sectional data from the instrument “COVID-19 Barometer: Social Opinion” in Portugal (March 2020 and September 2021) and from “COVID-19 Social Thermometer” in Brazil (August 2020 to April 2021); these surveys included data regarding the health and socioeconomic impact on the population. The health and sociodemographic variables of the two countries were summarized as absolute and relative frequencies. A multivariable logistic regression model was fit by country to estimate the relation between FNF and selected variables of interest. Results: Approximately 36% of the sample studied reported anxiety, agitation, sadness, or low mood almost every day in Portugal and 52% in Brazil due to physical distancing. In Portugal, having more than two comorbidities represented a greater chance of experiencing FNF every day or almost every day (odds ratio [OR] = 1.51 [CI: 1.22–1.87]) than those without comorbidities. In contrast, having a university education level represented a protector factor (OR = 0.76 [CI: 0.67–0.88]). In Brazil, being unemployed increased the chance of FNF compared to students (OR = 11.2). Conclusions: Physical distancing measures have impacted the mental well-being of the young population in Portugal and Brazil. The countries must make a quick effort to attend to and protect young people’s well-being and mental health in the changing context of the current pandemic.

AimIdentify factors associated with COVID-19 intensive care unit (ICU) admission and death among hospitalized cases in Portugal, and variations from the first to the second wave in Portugal, March–December 2020.IntroductionDeterminants of ICU admission and death for COVID-19 need further understanding and may change over time. We used hospital discharge data (ICD-10 diagnosis-related groups) to identify factors associated with COVID-19 outcomes in two epidemic periods with different hospital burdens to inform policy and practice.MethodsWe conducted a retrospective cohort study including all hospitalized cases of laboratory-confirmed COVID-19 in the Portuguese NHS hospitals, discharged from March to December 2020. We calculated sex, age, comorbidities, attack rates by period, and calculated adjusted relative risks (aRR) for the outcomes of admission to ICU and death, using Poisson regressions. We tested effect modification between two distinct pandemic periods (March–September/October–December) with lower and higher hospital burden, in other determinants.ResultsOf 18,105 COVID-19 hospitalized cases, 10.22% were admitted to the ICU and 20.28% died in hospital before discharge. Being aged 60–69 years (when compared with those aged 0–49) was the strongest independent risk factor for ICU admission (aRR 1.91, 95%CI 1.62–2.26). Unlike ICU admission, risk of death increased continuously with age and in the presence of specific comorbidities. Overall, the probability of ICU admission was reduced in the second period but the risk of death did not change. Risk factors for ICU admission and death differed by epidemic period. Testing interactions, in the period with high hospital burden, those aged 80–89, women, and those with specific comorbidities had a significantly lower aRR for ICU admission. Risk of death increased in the second period for those with dementia and diabetes.Discussion and conclusionsThe probability of ICU admission was reduced in the second period. Different patient profiles were identified for ICU and deaths among COVID-19-hospitalized patients in different pandemic periods with lower and higher hospital burden, possibly implying changes in clinical practice, priority setting, or clinical presentation that should be further investigated and discussed considering impacts of higher burden on services in health outcomes, to inform preparedness, healthcare workforce planning, and pandemic prevention measures.

Chagas disease is a neglected infectious disease caused by the protozoan Trypanosoma cruzi, primarily transmitted by triatomine vectors, and it threatens approximately seventy-five million people worldwide. This parasite undergoes a complex life cycle, transitioning between hosts and shifting from extracellular to intracellular stages. To ensure its survival in these diverse environments, T. cruzi undergoes extreme morphological and molecular changes. The metacyclic trypomastigote (MT) form, which arises from the metacyclogenesis (MTG) process in the triatomine hindgut, serves as a crucial link between the insect and human hosts and can be considered the starting point of Chagas disease. This review provides an overview of the current knowledge regarding the parasite’s life cycle, molecular pathways, and mechanisms involved in metabolic and morphological adaptations during MTG, enabling the MT to evade the immune system and successfully infect human cells.

IntroductionIn Portugal, COVID-19 laboratory notifications, clinical notifications (CNs), and epidemiological investigation questionnaires (EI) were electronically submitted by laboratories, clinicians, and public health professionals, respectively, to the Portuguese National Epidemiological Surveillance System (SINAVE), as mandated by law. We described CN and EI completeness in SINAVE to inform pandemic surveillance efforts.MethodsWe calculated the proportion of COVID-19 laboratory-notified cases without CN nor EI, and without EI by region and age group, in each month, from March 2020 to July 2021. We tested the correlation between those proportions and monthly case counts in two epidemic periods and used Poisson regression to identify factors associated with the outcomes.ResultsThe analysis included 909,720 laboratory-notified cases. After October 2020, an increase in the number of COVID-19 cases was associated with a decrease in the submissions of CN and EI. By July 2021, 68.57% of cases had no associated CN nor EI, and 96.26% had no EI. Until January 2021, there was a positive correlation between monthly case counts and the monthly proportion of cases without CN nor EI and without EI, but not afterward. Cases aged 75 years or older had a lower proportion without CN nor EI (aRR: 0.842 CI95% 0.839–0.845). When compared to the Norte region, cases from Alentejo, Algarve, and Madeira had a lower probability of having no EI (aRR;0.659 CI 95%0.654–0.664; aRR 0.705 CI 95% 0.7–0.711; and aRR 0.363 CI 95% 0.354–0.373, respectively).DiscussionAfter January 2021, CN and EI were submitted in a small proportion of laboratory-confirmed cases, varying by age and region. Facing the large number of COVID-19 cases, public health services may have adopted other registry strategies including new surveillance and management tools to respond to operational needs. This may have contributed to the abandonment of official CN and EI submission. Useful knowledge on the context of infection, symptom profile, and other knowledge gaps was no longer adequately supported by SINAVE. Regular evaluation of pandemic surveillance systems' completeness is necessary to inform surveillance improvements and procedures considering dynamic objectives, usefulness, acceptability, and simplicity.

Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.

Desenvolvida na França entre 1950 e 1960 por pedagogos, psiquiatras e psicanalistas, a pedagogia institucional aposta nas trocas e nas mediações em grupo e na noção de coletivo, promovendo atividades e dinâmicas diversas para desencadear a reciprocidade e acirrar a dialogicidade na criação de saídas de conflitos e impasses no ambiente escolar e de formação. Ainda pouco conhecida no Brasil em seu viés mais atravessado pela psicanálise, essa corrente pedagógica se vale da premissa da divisão subjetiva para discutir questões de ensino-aprendizagem e de formação de professores, dando enfoque particular a situações em que a subjetividade se deixa flagrar nas práticas pedagógicas. Para esse ponto também convergem os estudos discursivos franco-brasileiros, que semelhantemente se deixam afetar pela psicanálise freudo-lacaniana e se interessam pela mesma temática. A entrevista que se segue resultou de uma missão de pesquisa com o Prof. XXXX, na Universidade YYYY, em 2019. Ela materializa um diálogo profícuo entre dois pesquisadores de campos distintos, interessados nos mesmos temas, abordando a importância da prática linguageira nos dispositivos que privilegiam formas de subjetivação na formação de professores e a relação entre linguagem e subjetividade.

Abstract Daily medication use can be affected by the gradual loss of functional ability. Thus, elderly patients are at risk for nonadherence due to functional decline, namely, decreases in cognitive skills and visual and manual dexterity. The main objective was to assess the ability of older people to self-manage their medication and to identify the main predictors for unintentional nonadherence. A cross-sectional study was conducted (2014–2017) in community centers and pharmacies. Functional assessment was performed with the Portuguese versions of the Drug Regimen Unassisted Grading Scale (DRUGS-PT) and the Self-Medication Assessment Tool (SMAT-PT). A purposive sample including 207 elderly patients was obtained. To identify the main predictors, binary logistic regression was performed. The average DRUGS-PT score was slightly lower than that in other studies. On the SMAT-PT, the greatest challenge for patients was identifying medications by reading labels/prescriptions. The main difficulties identified were medication memorization and correct schedule identification. The scores were higher with the real regimen than with the simulated regimen, underlining the difficulties for patients in receiving new information. Regarding the predictors of an older individual’s ability to self-manage medications, two explanatory models were obtained, with very high areas under the curve (> 90%). The main predictors identified were cognitive ability, level of schooling and daily medication consumption.

Abstract Background Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis. Methods Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05. Results Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19–71), 8 days (IQR: 1–32) and 62 days (IQR: 38–102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay. Conclusions Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.

Abstract Background Increasing evidence indicates that the first wave of the COVID-19 pandemic had immediate health and social impact, disproportionately affecting certain socioeconomic groups. Assessing inequalities in risk of exposure and in adversities faced during the pandemic is critical to inform targeted actions that effectively prevent disproportionate spread and reduce social and health inequities. This study examines i) the socioeconomic and mental health characteristics of individuals working in the workplace, thus at increased risk of COVID-19 exposure, and ii) individual income losses resulting from the pandemic across socioeconomic subgroups of a working population, during the first confinement in Portugal. Methods This study uses data from ‘COVID-19 Barometer: Social Opinion’, a community-based online survey in Portugal. The sample for analysis comprised n = 129,078 workers. Logistic regressions were performed to estimate the adjusted odds ratios (AOR) of factors associated with working in the workplace during the confinement period and with having lost income due to the pandemic. Results Over a third of the participants reported working in the workplace during the first confinement. This was more likely among those with lower income [AOR = 2.93 (2.64-3.25)], lower education [AOR = 3.17 (3.04-3.30)] and working as employee [AOR = 1.09 (1.04-1.15)]. Working in the workplace was positively associated with frequent feelings of agitation, anxiety or sadness [AOR = 1.14 (1.09-1.20)] and perception of high risk of infection [AOR = 11.06 (10.53-11.61)]. About 43% of the respondents reported having lost income due to the pandemic. The economic consequences affected greatly the groups at increased risk of COVID-19 exposure, namely those with lower education [AOR = 1.36 (1.19-1.56)] and lower income [AOR = 3.13 (2.47-3.96)]. Conclusions The social gradient in risk of exposure and in economic impact of the pandemic can result in an accumulated vulnerability for socioeconomic deprived populations. The COVID-19 pandemic seems to have a double effect in these groups, contributing to heightened disparities and poor health outcomes, including in mental health. Protecting the most vulnerable populations is key to prevent the spread of the disease and mitigate the deepening of social and health disparities. Action is needed to develop policies and more extensive measures for reducing disproportionate experiences of adversity from the COVID-19 pandemic among most vulnerable populations.

Abstract Background Delay in Tuberculosis (TB) diagnosis affects foreign-born and nationals in different ways, especially in low-incidence countries. This study characterises total delay and its components amongst foreign-born individuals in Portugal. Additionally, we identify risk factors for each type of delay and compare their effects between foreign-born and nationals. Methods We analysed data from the Portuguese TB surveillance system and included individuals with pulmonary TB (PTB), notified between 2008 and 2017. We described patient, healthcare, and total delays. Cox regression was used to identify factors associated with each type of delay. All analyses were stratified according to the origin country: nationals (those born in Portugal) and foreign-born. Results Compared with nationals, foreign-born persons presented statistically significant and longer median total and patient delays (Total: 67 vs. 63; Patient: 44 vs. 36 days), and lower healthcare services delays (7 vs. 9 days). Risk factors for delayed diagnosis differed between foreign-born and nationals. Being unemployed, having drug addiction, and having comorbidities were identified as risk factors for delayed diagnosis in national individuals but not in foreigners. Alcohol addiction was the only factor identified for healthcare delay for both populations: foreign-born (Hazard Ratio 1.34 [95% confidence interval 1.17;1.53]); nationals (Hazard Ratio 1.20 [95% confidence interval 1.13;1.27]). Conclusions Foreign-born individuals with PTB take longer to seek health care. While no specific risk factors were identified, more in-depth studies are required to identify barriers and support public health intervention to address PTB diagnosis delay in foreign-born individuals.

Abstract Background Worldwide, the current management of knee osteoarthritis appears heterogeneous, high-cost and often not based on current best evidence. The absence of epidemiological data regarding the utilisation of healthcare services may conceal the need for improvements in the management of osteoarthritis. The aim of this study is to explore the profiles of healthcare services utilisation by people with knee osteoarthritis, and to analyse their determinants, according to Andersen’s behavioural model. Methods We analysed a sample of 978 participants diagnosed with knee osteoarthritis from the population-based study EpiReumaPt, in Portugal. Data was collected with a structured interview, and the diagnosis of knee osteoarthritis was validated by a rheumatologist team. With the Two-step Cluster procedure, we primarily identified different profiles of healthcare utilisation according to the services most used by patients with knee osteoarthritis. Secondly, we analysed the determinants of each profile, using multinomial logistic regression, according to the predisposing characteristics, enabling factors and need variables. Results In our sample, a high proportion of participants are overweight or obese (82,6%, n = 748) and physically inactive (20,6%, n = 201) and a small proportion had physiotherapy management (14,4%, n = 141). We identified three profiles of healthcare utilisation: “HighUsers”; “GPUsers”; “LowUsers”. “HighUsers” represents more than 35% of the sample, and are also the participants with higher utilisation of medical appointments. “GPUsers” represent the participants with higher utilisation of general practitioner appointments. Within these profiles, age and geographic location – indicated as predisposing characteristics; employment status and healthcare insurance - as enabling factors; number of comorbidities, physical function, health-related quality of life, anxiety and physical exercise - as need variables, showed associations (p

Resumo A entrevista aborda a trajetória das políticas e práticas de redução de danos no Brasil por meio do depoimento da redutora de danos Fátima Machado. A perspectiva de redução de danos surgiu na Europa, na década de 1980, e no Brasil iniciou em 1989, como estratégia de prevenção à aids entre usuários de drogas injetáveis, e depois se diversificou e ampliou. A entrevista focaliza os anos iniciais de desenvolvimento dessas práticas inovadoras e problematiza seus desdobramentos atuais. Fátima Machado foi uma das precursoras no trabalho de campo e ativismo da redução de danos no Brasil e uma das fundadoras da Associação Brasileira de Redutores de Danos.

Introdução – O bullying pode ser definido como atitudes agressivas, intencionais e repetidas durante um período de tempo. Diversos estudos verificaram a prevalência de bullying entre estudantes de vários países e demonstraram que este é um problema internacional e que pelo menos um em cada dez estudantes está envolvido numa situação de bullying. Objetivos – Caracterizar as situações de bullying no ambiente escolar, o papel do estudante, os sentimentos associados a essas ações e identificar as características do agressor. Métodos – A amostra foi constituída por 519 alunos matriculados em duas escolas da região sul de Portugal que preencheram um questionário anónimo sobre uma situação de bullying que vivenciaram, descrevendo o papel do aluno e o que sentiram nesta situação. Resultados – Os resultados revelaram que em 61,7% dos casos se tratou de agressão física e 29,7% de agressão verbal. Desempenharam o papel de agressores 12,7% dos alunos, 21,8% foram vítimas e 63,6% foram testemunhas desta situação. 10,6% dos alunos relataram sentir bem, 11% mostraram indiferença e 78,4% dos alunos sentiram-se mal com a situação de bullying. Verificou-se que, com o avanço da idade, o estudante aumentava em 1,5 vezes a probabilidade de desempenhar o papel de agressor e os rapazes apresentavam 5,2 vezes mais probabilidades de vir a ser agressor numa situação de bullying. Conclusão – O presente estudo verificou que a maioria dos alunos participou de uma situação de bullying escolar como testemunha, sendo os casos mais comuns de agressão física. A maioria dos alunos sentiu-se mal com essa situação. Os rapazes e os alunos com mais idade tiveram mais probabilidade de vir a desempenhar o papel de agressor numa situação de bullying.

Objectives To examine the association between the perception of COVID-19 risk, confidence in health services and avoidance of emergency department (ED) visits in Portugal during the COVID-19 pandemic.Design Community-based, cross-sectional survey.Setting Volunteer sample that completed the online survey between April 2020 and May 2021.Participants 987 participants who perceived needing ED care. Of those, 242 reported avoiding ED visits.Outcome measures Logistic regression models for ED avoidance were conducted to estimate the effect of risk perception and confidence in health services, adjusted for sociodemographics, health status and time.Results The adjusted odds for ED avoidance were higher for participants lacking confidence in health service response to non-COVID-19 conditions (adjusted OR: 6.39; 95% CI 3.19 to 12.82) and COVID-19 (1.81; 1.19 to 2.77) and lower for those perceiving a low risk of being infected at a health provider (0.16; 0.07 to 0.38).Conclusion In our sample, confidence in health services and risk perception of infection at a health provider were associated with the decision to avoid the ED. These results suggest that policymakers and care providers need to mitigate the negative consequences of delayed healthcare; be aware of the implications of distrust and fear from those in need of healthcare and provide equally distributed safe alternatives to ED care.

Background: Timeliness of care is an important dimension of healthcare quality but it’s unclear whether it improves clinical outcomes in lung cancer (LC) patients. Objectives: This study aims to analyze treatment patterns, time-to-treatment (TTT) and the impact of treatment timeliness (TT) in overall survival (OS) of patients diagnosed with LC in 2009–2014 in a population-based registry from Southern Portugal. Materials and Methods: We estimated median TTT for overall population, treatment type and stage. The impact of treatment and TT on five-year OS was analyzed using the Kaplan-Meier method and Cox regression modelling to determine the hazard ratio (HR) of death associated with treatment and TT. Results: From the 11,308 cases diagnosed, 61.7% received treatment. Treatment rate decreased with increasing stage from 88% in stage I to 66.1% in stage IV. Overall median TTT was 49 days (IQR: 28–88) and 43.3% received TT. Surgery had a longer TTT than radiotherapy and systemic treatment. Patients in earlier stages had lower TT rates and longer TTT compared to more advanced, 24.7% and 80 days in stage I versus 51.3% and 42 days in stage IV (p < 0.0001). OS was 14.9% for total population and 19.6% and 7.1% for patients with and without treatment registered, respectively. TT had no observed impact on OS for stages I/II but a negative effect for stages III/IV. Relative to treated, the adjusted mortality risk was higher in untreated patients (HR = 2.240; 95%CI: 2.293–2.553). Contrary to treatment, TT had a negative impact on survival, with 11.3% in timely vs. 21.5% in untimely treated. Compared to untimely treated, the risk of death in TT patients was 46.6% higher (HR = 1.465; 95%CI: 1.381–1.555). Conclusions: LC survival is highly dependent on early diagnosis and adequate treatment. Time-to-treatment was longer than recommended for all treatment types but particularly for surgery. Overall TT results were paradoxical, as better survival was observed in patients untimely treated. The factors associated with TT were not possible to analyze and its impact on patient outcomes remains unclear. However, it is important to assess quality-of-care to improved LC management.

Abstract Background The impact of the COVID-19 pandemic has been measured in different metrics, mostly by counting deaths and its impact on health services. Few studies have attempted to calculate years of life lost (YLL) to COVID-19 and compare it with YLL due to other causes in different countries. Methods We calculated YLL to COVID-19 from week10 to week52 in 2020 for eight European countries by methods defined by the WHO. We calculated excess YLL by subtracting the average YLL from 2017 to 2019 to the YLL in 2020. Our analysis compared YLL to COVID-19 and the excess YLL of non-COVID-19 causes across countries in Europe. Results Portugal registered 394,573 cases and 6619 deaths due to COVID-19, accounting for 25,395 YLL in just 10 months. COVID-19 was responsible for 6.7% of all deaths but accounted for only 4.2% of all YLL. We estimate that Portugal experienced an excess of 35,510 YLL (+ 6.2%), of which 72% would have been due to COVID-19 and 28% due to non-COVID-19 causes. Spain, Portugal, and the Netherlands experienced excess YLL to non-COVID-19 causes. We also estimated that Portugal experienced an excess of 10,115 YLL due to cancer (3805), cardiovascular diseases (786) and diseases of the respiratory system (525). Conclusion COVID-19 has had a major impact on mortality rates in Portugal, as well as in other European countries. The relative impact of COVID-19 on the number of deaths has been greater than on the number of YLL, because COVID-19 deaths occur mostly in advanced ages.

Abstract Background A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. Methods We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient’s diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox’s regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value

Background: At the end of January 2021, Portugal had over 700,000 confirmed COVID-19 cases. The burden of COVID-19 varies between and within countries due to differences in contextual and individual factors, transmission rates, and clinical and public health interventions. Objectives: To identify high-risk areas, between April and October, on a weekly basis and at the municipality level, and to assess the temporal evolution of COVID-19, considering municipalities classified by incidence levels. Methods: This is an ecological study following a 3-step approach, i.e., (1) calculation of the relative risk (RR) of the number of new confirmed COVID-19 cases, weekly, per municipality, using a spatial scan analysis; (2) classification of the municipalities according to the European Centre for Disease Control incidence categorization on November 19; and (3) characterization of RR temporal evolution by incidence groups. Results: Between April and October, the mean RR was 0.53, with a SD of 1.44, varying between 0 and 46.4. Globally, the north and Lisbon and Tagus Valley (LVT) area were the regions with the highest number of municipalities with a RR above 3.2. In April and beginning of May, most of the municipalities with an RR above 3.2 were from the north, while between May and August most municipalities with an RR above 3.2 were from LVT area. Comparing the incidence in November and retrospectively analyzing the RR showed the huge variation, with municipalities with an RR of 0 at a certain time classified as extremely high in November. Conclusions: Our results showed considerable variation in RR over time and space, with no consistent “better” or “worst” municipality. In addition to the several factors that influence COVID-19 transmission dynamics, there were some outbreaks over time and throughout the country and this may contribute to explaining the observed variation. Over time, on a weekly basis, it is important to identify critical areas allowing tailored and timely interventions in order to control outbreaks in early stages.

The production of cultured limpets is a recent research field contributing to aquaculture diversification, focusing on low trophic species while reducing the carbon footprint. Limpets are gastropods that colonize rocky substrates and are mostly present on tidal and subtidal shores. This animal group is in high commercial demand and is endangered in several regions. The aquaculture production of limpets has been traditionally challenging. The most successful reproduction method has been gonadal dissection, as artificial spawning induction has shown limited success to date. Moreover, methods for larval culture, settlement, and juvenile growth have been poorly developed and remain largely unknown. In recent years, advances in this field have led to the optimization of methods to enhance larval production, larval culture, settlement induction of competent larvae, and management of post-larvae and juveniles. The present manuscript reviews these advances, obtained within the framework of AQUAINVERT project, focusing on broodstock management, gametes release, larval production, larviculture, settlement, and grow-out of post-larvae, and providing an update on the actual state of the art in limpets’ aquaculture.

Triatomines have evolved salivary glands that produce versatile molecules with various biological functions, including those leading their interactions with vertebrate hosts’ hemostatic and immunological systems. Here, using high-throughput transcriptomics and proteomics, we report the first sialome study on the synanthropic triatomine Triatoma sordida. As a result, 57,645,372 reads were assembled into 26,670 coding sequences (CDS). From these, a total of 16,683 were successfully annotated. The sialotranscriptomic profile shows Lipocalin as the most abundant protein family within putative secreted transcripts. Trialysins and Kazal-type protease inhibitors have high transcript levels followed by ubiquitous protein families and enzyme classes. Interestingly, abundant trialysin and Kazal-type members are highlighted in this triatomine sialotranscriptome. Furthermore, we identified 132 proteins in T. sordida salivary gland soluble extract through LC-MS/MS spectrometry. Lipocalins, Hemiptera specific families, CRISP/Antigen-5 and Kazal-type protein inhibitors proteins were identified. Our study provides a comprehensive description of the transcript and protein compositions of the salivary glands of T. sordida. It significantly enhances the information in the Triatominae sialome databanks reported so far, improving the understanding of the vector’s biology, the hematophagous behaviour, and the Triatominae subfamily’s evolution.

Background: Tuberculosis (TB) is one of the top 10 causes of death worldwide; in 2016, over 95% of TB deaths occurred in low- and middle-income countries. Although the incidence and deaths from TB have decreased in Brazil in recent years, the disease has increased in the vulnerable population, whose diagnosis is more delayed and the chances for abandonment and deaths are significantly higher. This study aimed to identify high-risk areas for TB mortality and evidence their social determinants through a sensitive tailored social index, in a context of high inequality in South Brazil. Methods: A multistep statistical methodology was developed, based on spatial clustering, categorical principal components analysis, and receiver operating characteristic curves (ROC). This study considered 138 spatial units in Curitiba, South Brazil. TB deaths (2008–2015) were obtained from the National Information Mortality System and social variables from the Brazilian Human Development Atlas (2013). Results: There were 128 TB deaths recorded in the study: the mortality rate was 0.9/100,000 inhabitants, minimum–maximum: 0–25.51/100,000, with a mean (standard deviation) of 1.07 (2.71), and 78 space units had no deaths. One risk cluster of TB mortality was found in the south region (RR = 2.64, p = 0.01). Considering the social variables, several clusters were identified in the social risk indicator (SRI): income (899.82/1752.94; 0.024), GINI Index (0.41/0.45; 0.010), and overcrowding (25.07/15.39; 0.032). The SRI showed a high capacity to discriminate the TB mortality areas (area under ROC curve 0.865, 95% CI: 0.796–0.934). Conclusions: A powerful risk map (SRI) was developed, allowing tailored and personalised interventions. The south of Curitiba was identified as a high-risk area for TB mortality and the majority of social variables. This methodological approach can be generalised to other areas and/or other public health problems.

Introduction: Breast cancer (BC) is the most common cancer among Portuguese women and it is associated with high hospitalization rates. Therefore, this study aims to characterize the BC hospital admission rate (HAR) in women in the period of 2002–2016, with an additional focus on spatiotemporal patterns of hospitalizations by BC (main code). Methods: After a descriptive analysis of all BC hospitalizations, the main BC code HAR was studied using mapping techniques, analysis of spatiotemporal clusters, and analysis of spatial variations in temporal trends. Results: The BC-HAR was 118.72/105 women, showing a growth of 3.109% per year in this period. The median length of stay (LOS) in these patients was 5 days, and most cases were programmed surgical admissions. Several spatiotemporal clusters and spatial variations in temporal trends were detected. The seaside area of the country showed 4 high HAR clusters in the spatiotemporal analysis. Additionally, the seaside north of the country and 2 isolated counties presented significantly different temporal trends in BC-HAR versus the rest of the country. These clusters suggest regional asymmetries, as they showed differences in terms of: demographic characteristics (age at admission and rurality of county of residence), the type of admission, LOS, and outcomes of hospitalization. Conclusion: This study identified key areas of high BC-HAR and increasing trends for female HAR, providing evidence of spatial heterogeneities in this health indicator.

Abstract Background Health behaviours are shaped early in life and tend to occur in complex specific patterns. We aimed to characterise these patterns among Portuguese adolescents and their association with individual and contextual factors. Methods This study was based in the Portuguese 2009/10 survey of Health Behaviour in School-Aged Children Study, comprising 4036 adolescents. Individuals were grouped using two-step cluster analysis based on 12 behaviours regarding diet, physical activity, screen use and substance use. The association between clusters and individual and contextual factors was analysed using multinomial regression. Results The median age was 13,6, and 54% were female. Overweight and obesity were highly prevalent (25%). We identified four behavioural clusters: “Active screen users”, “Substance users”, “Healthy” and “Inactive low fruit and vegetable eaters”. Sociodemographics varied across clusters. The “Substance users” and “Active screen users” clusters were associated with poor family communication, academic performance and school attachment and violent behaviours, and the “Inactive low fruit and vegetable eaters” were associated with lower socioeconomic status. Conclusion The understanding of these health-compromising patterns and their social determinants is of use to Public Health, allowing tailored health-promoting interventions. Further research is needed to understand how cluster membership evolves and its influence on nutritional status.

Epidemic surveillance is a fundamental part of public health practice. Addressing under-ascertainment of cases is relevant in most surveillance systems, especially in pandemics of new diseases with a large spectrum of clinical presentations as it may influence timings of policy implementation and public risk perception. From this perspective, this article presents and discusses early evidence on under-ascertainment of COVID-19 and its motifs, options for surveillance, and reflections around their importance to tailor public health measures. In the case of COVID-19, systematically addressing and estimating under-ascertainment of cases is essential to tailor timely public health measures, and communicating these findings is of the utmost importance for policy making and public perception.

Abstract Background Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening. Method This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation. Results A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty. Conclusion The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.

Background: Knowledge on the settings and activities associated with a higher risk of SARS-CoV-2 transmission is essential to inform decision-making. We thus designed a case-control study to identify relevant settings for community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Portugal.Methods: We evaluated 1,088 cases, identified through the national surveillance system, and 787 community controls, recruited using random digit dialing. Sociodemographic characteristics, individual protective measures, and activities or visited settings were obtained through telephone interview. We report sex-, age-, education-, and citizenship-adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).Results: Household overcrowding (aOR = 1.47; 95% CI 1.14–1.91) and work in senior care (4.99; 1.30–33.08) increased while working remotely decreased the risk of infection (0.30; 0.22–0.42). Going to restaurants/other dining spaces (0.73; 0.59–0.91), grocery stores (0.44; 0.34–0.57) or hair salons (0.51; 0.39–0.66), or the use of public transportation did not present a higher risk of infection (0.98; 0.75–1.29), under existing mitigation strategies. Lower education ( ≤ 4 years vs. tertiary education: 1.79; 1.33–2.42) and no Portuguese citizenship (5.47; 3.43–9.22) were important risk factors.Conclusions: The utilization of public transportation, restaurants, and commercial spaces was not associated with increased risk of infection, under capacity restrictions, physical distancing, use of masks, and hygiene measures. Overcrowding, foreign citizenship, low education and working on-site were positively associated with SARS-CoV-2 infection.

Background: Hip/knee osteoarthritis (HKOA) is a leading cause of disability and imposes a major socioeconomic burden. The aim of this study is to estimate the prevalence of HKOA in Portugal, characterised the clinical severity of HKOA in the population, and identified sociodemographic, lifestyle, and clinical factors associated with higher clinical and radiographic severity.Methods: Participants with a diagnosis of HKOA from the EpiReumaPt study (2011–2013) were included (n = 1,087). Hip/knee osteoarthritis diagnosis was made through a structured evaluation by rheumatologists according to American College of Rheumatology criteria. Clinical severity was classified based on Hip Disability and Osteoarthritis Outcome Scale (HOOS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) score tertiles. Radiographic severity was classified based on the Kellgren-Lawrence grades as mild, moderate, or severe. Sociodemographic lifestyle and clinical variables, including the presence of anxiety and depression symptoms, were analysed. Factors associated with higher clinical and radiographic severity were identified using ordinal logistic regression models.Results: Hip/knee osteoarthritis diagnosis was present in 14.1% of the Portuguese population [12.4% with knee osteoarthritis (OA) and 2.9% with hip OA]. Clinical severity was similar between people with hip (HOOS = 55.79 ± 20.88) and knee (KOOS = 55.33 ± 20.641) OA. People in the high HOOS/KOOS tertile tended to be older (64.39 ± 0.70 years), female (75.2%), overweight (39.0%) or obese (45.9%), and had multimorbidity (86.1%). Factors significantly associated with higher clinical severity tertile were age [55–64 years: odds ratio (OR) = 3.18; 65–74 years: OR = 3.25; ≥75 years: OR = 4.24], female sex (OR = 1.60), multimorbidity (OR = 1.75), being overweight (OR = 2.01) or obese (OR = 2.82), and having anxiety symptoms (OR = 1.83). Years of education was inversely associated with higher clinical severity. Factors significantly associated with higher radiographic severity were age (65–74 years: OR = 3.59; ≥75 years: OR = 3.05) and being in the high HOOS/KOOS tertile (OR = 4.91). Being a female and live in Lisbon or in the Centre region were inversely associated with the higher radiographic severity.Conclusion: Hip/knee osteoarthritis is present in ~1.1 million of Portuguese people. Age, educational level, and obesity are independently associated with HKOA clinical severity, whereas age, sex, geographic location, and clinical severity are independently associated with radiographic severity.

The present study aimed to investigate the epidemiological situation of leprosy (Hansen's Disease), in a hyperendemic metropolis in the Central-West region of Brazil. We studied trends over eleven years, both in the detection of the disease and in disabilities, analyzing disparities and/or differences regarding gender and age. This is an ecological time series study conducted in Cuiabá, capital of the state of Mato Grosso. The population consisted of patients diagnosed with leprosy between the years 2008 and 2018. The time series of leprosy cases was used, stratifying it according to gender (male and female), disability grade (G0D, G1D, G2D, and not evaluated) and age. The calendar adjustment technique was applied. For modeling the trends, the Seasonal-Trend decomposition procedure based on Loess (STL) was used. We identified 9.739 diagnosed cases, in which 58.37% were male and 87.55% aged between 15 and 59 years. Regarding detection according to gender, there was a decrease among women and an increase in men. The study shows an increasing trend in disabilities in both genders, which may be related to the delay in diagnosis. There was also an increasing number of cases that were not assessed for disability at the time of diagnosis, which denotes the quality of the services.

Leishmania braziliensis is the most important causal agent of American tegumentary leishmaniasis (ATL), and 3 to 5% of patients develop mucosal lesions. The mechanisms related to parasite and host immune interactions and the parasite life cycle that lead to dissemination to the mucosa are poorly understood. We aimed to detect L. braziliensis DNA in the nasal mucosa of cutaneous leishmaniasis (CL) patients with early mucous dissemination and to relate those findings to specific inflammatory responses. Nasal swabs were collected from patients with the cutaneous form of ATL. L. braziliensis DNA was investigated using TaqMan-based real-time PCR. The levels of serum cytokines (IL-12, IL-6, TNF-α, IL-10, IL-1β and IL-8) were measured by a multiplex cytometric array. A Poisson regression model was used to test prevalence ratios (PRs) and multivariate interactions of clinical and laboratory characteristics. Of the 79 CL patients, 24 (30%) had L. braziliensis DNA in the nasal mucosa. In the multivariate model, parasite DNA presence in mucosa was associated with a reduction in IL-12 levels (PR = 0.440; p=0.034), increased IL-6 levels (PR = 1.001; p=0.002) and a higher number of affected body segments (PR = 1.65; p

Introduction Knee osteoarthritis (OA) is a prevalent condition with associated high disability and healthcare costs. Evidence of major gaps in the implementation of evidence-based interventions in people with knee OA led several healthcare systems to implement models of care (MoCs) in order to improve knowledge translation and guaranty their economic sustainability. Nevertheless, there are few studies that analyse the existing body of evidence of MoCs for patients with knee OA in primary healthcare settings. Therefore, we aim to identify MoCs developed for patients with knee OA implemented in primary healthcare and, analyse their core components and outcomes. This scoping review will create knowledge about the components and outcomes of these MoCs which, in the future, will facilitate their transferability to practice.Methods and analysis We will include studies that developed and implemented an MoC for people with knee OA in primary healthcare. We will use the PCC mnemonic, being ‘Population’—people with Knee OA, ‘Concept’—the MoCs and ‘Context’—the primary healthcare setting. We will conduct the search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, as well as grey literature databases and relevant institutions and organisations websites, for articles published after 2000. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess papers regarding their eligibility. We will evaluate the methodological quality of the included studies with the Mixed Methods Appraisal tool and apply a data abstraction form to describe and interpret the evidence.Ethics and dissemination As a secondary analysis, this scoping review does not require ethical approval. Findings will be published in peer-review journal, presented in scientific conferences and as a summary through primary healthcare units.

Background: We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors. Methods: A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram. Results: The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20–39 years (21.8%), had 4–7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy. Conclusion: The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.

Abstract Background Tuberculosis (TB) is the infectious disease that kills the most people worldwide. The use of geoepidemiological techniques to demonstrate the dynamics of the disease in vulnerable communities is essential for its control. Thus, this study aimed to identify risk clusters for TB deaths and their variation over time. Methods This ecological study considered cases of TB deaths in residents of Londrina, Brazil between 2008 and 2015. We used standard, isotonic scan statistics for the detection of spatial risk clusters. The Poisson discrete model was adopted with the high and low rates option used for 10, 30 and 50% of the population at risk, with circular format windows and 999 replications considered the maximum cluster size. Getis-Ord Gi* (Gi*) statistics were used to diagnose hotspot areas for TB mortality. Kernel density was used to identify whether the clusters changed over time. Results For the standard version, spatial risk clusters for 10, 30 and 50% of the exposed population were 4.9 (95% CI 2.6–9.4), 3.2 (95% CI: 2.1–5.7) and 3.2 (95% CI: 2.1–5.7), respectively. For the isotonic spatial statistics, the risk clusters for 10, 30 and 50% of the exposed population were 2.8 (95% CI: 1.5–5.1), 2.7 (95% CI: 1.6–4.4), 2.2 (95% CI: 1.4–3.9), respectively. All risk clusters were located in the eastern and northern regions of the municipality. Additionally, through Gi*, hotspot areas were identified in the eastern and western regions. Conclusions There were important risk areas for tuberculosis mortality in the eastern and northern regions of the municipality. Risk clusters for tuberculosis deaths were observed in areas where TB mortality was supposedly a non-problem. The isotonic and Gi* statistics were more sensitive for the detection of clusters in areas with a low number of cases; however, their applicability in public health is still restricted.

Abstract Background Adolescence is a critical period of vulnerability to substance use. Recent research has shown that gender differences in adolescence substance use are complex and in constant flux. The present study aims to investigate gender differences in substance use and initiation patterns in male and female adolescents, and to assess individual, family, peer, and school associated factors of these patterns. Methods We applied latent class regression analysis to a Portuguese representative population sample of 1551 15-year-old adolescents, drawn from the 2010 ‘Health Behavior in School-Aged Children’ survey, to characterise different profiles of substance use and initiation for boys and girls, and to identify factors associated with latent class membership, stratifying the associations analysis by gender. Results Three common classes were found for both genders, specifically, Non-Users (boys [B] 34.42%, girls [G] 26.79%), Alcohol Experimenters (B 38.79%, G 43.98%) and Alcohol and Tobacco Frequent Users (B 21.31%, G 10.36%), with two additional unique classes: Alcohol Experimenters and Tobacco Users in girls (18.87%), and Early Initiation and Poly-Substance Users in boys (5.48%). Poor school satisfaction, bullying, fighting and higher family affluence scale score formed a common core of associated factors of substance use, although we found gender differences in these associations. In girls, but not in boys, family factors were associated with more problematic substance use. Not living with both parents was associated with girl’s Alcohol and Tobacco Frequent Users (gATFU) class (OR 3.78 CI 1.18–12.11) and Alcohol Experimenters and Tobacco Users (AETU) class (OR 3.22 CI 1.4–7.44). Poor communication with mother was also associated with gATFU class membership (OR 3.82 CI 1.26–11.53) and AETU class (OR 3.66 CI 1.99–6.75). Additionally, a higher psychological symptoms score was associated with gATFU class membership (OR 1.16 CI 1.02–1.31). Conclusion Although we found common patterns and associated factors between boys and girls, we report two unique patterns of substance use in boys and girls and specific associations between family, school and peers, and individual factors with these patterns. These findings underscore the need for substance use prevention and health promotion programmes that address potential differences in substance use patterns and associated factors.

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade. Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included. Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta. Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes. Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

Objectives. This study is aimed at identifying the best clinical model to predict poststroke independence at 6 and 18 months, considering sociodemographic and clinical characteristics, and then identifying differences between countries. Methods. Data was retrieved from the International Stroke Trial 3 study. Nine clinical variables (age, gender, severity, rt-PA, living alone, atrial fibrillation, history of transient ischemic attack/stroke, and abilities to lift arms and walk) were measured immediately after the stroke and considered to predict independence at 6 and 18 months poststroke. Independence was measured using the Oxford Handicap Scale. The adequacy, predictive capacity, and discriminative capacity of the models were checked. Countries were added to the final models. Results. At 6 months poststroke, 35.8% (n=1088) of participants were independent, and at 18 months, this proportion decreased to 29.9% (n=747). Both 6 and 18 months poststroke predictive models obtained fair discriminatory capacities. Gender, living alone, and rt-PA only reached predictive significance at 18 months. Poststroke patients from Poland and Sweden showed greater chances to achieve independence at 6 months compared to the UK. Poland also achieved greater chances at 18 months. Italy had worse chances than the UK at both follow-ups. Discussion. Six and eight variables predicted poststroke independence at 6 and 18 months, respectively. Some variables only reached significance at 18 months, suggesting a late influence in stroke patients’ rehabilitation. Differences found between countries in achieving independence may be related to healthcare system organization or cultural characteristics, a hypothesis that must be addressed in future studies. These results can allow the development of tailored interventions to improve the outcomes.

Introduction: COVID-19 is a viral respiratory disease, which became a global threat to public health. Specific subsets of the population are more vulnerable, namely those with chronic diseases. We aimed to estimate the share of the Portuguese population at the highest risk for complications following COVID-19 infection due to both old age and specific comorbidities. Material and Methods: Our sample included all people aged 65 years and above (2215 men and 3486 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. In order to project the potential population at highest risk for COVID-19, we used the latest available official demographic estimates from the National Institute of Statistics - INE 2018. We used a more restrictive definition of risk combining old age criteria and the following chronic conditions as potential risk factors for COVID-19 according to the available literature: hypertension, diabetes, chronic obstructive pulmonary disease, cardio- and cerebrovascular disease. Results: We estimated that 15.5% (n = 1 560 667) of the Portuguese population might be at increased risk for complications from COVID-19 because of old age and existing chronic conditions. Such estimates vary across the country (from 1.7% in Azores to 33.7% in Northern Portugal). Northern Portugal not only has the highest prevalence of selected morbidity (72.8%) within mainland Portugal, but also has the largest population at risk for COVID-19 (n = 526 607). This was followed by the Lisbon and Tagus Valley region (n = 408 564) and Central Portugal (n = 388 867). Discussion: Our results should encourage authorities to continue protecting those more vulnerable to the pandemic threat, particularly on those areas of the country which are more likely to be further affected. Conclusion: We projected a considerable number of Portuguese people at the highest risk for severe COVID-19 disease due to both old age and pre-existing chronic conditions. Such estimates vary across the country.

An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September–November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the community-based survey, “COVID-19 Barometer: Social Opinion”. Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.

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.

Triatomines are hematophagous insects that transmit Trypanosoma cruzi, the etiological agent of Chagas disease. This neglected tropical disease represents a global health issue as it is spreading worldwide. The saliva of Triatominae contains miscellaneous proteins crucial for blood feeding acquisition, counteracting host's hemostasis while performing vasodilatory, anti-platelet and anti-coagulant activities, besides modulating inflammation and immune responses. Since a set of biological processes are mediated by protein complexes, here, the sialocomplexomes (salivary protein complexes) of five species of Triatominae were studied to explore the protein-protein interaction networks. Salivary multiprotein complexes from Triatoma infestans, Triatoma dimidiata, Dipetalogaster maxima, Rhodnius prolixus, and Rhodnius neglectus were investigated by Blue-Native- polyacrylamide gel electrophoresis coupled with liquid chromatography tandem mass spectrometry. More than 70 protein groups, uncovering the landscape of the Triatominae salivary interactome, were revealed. Triabin, actin, thioredoxin peroxidase and an uncharacterized protein were identified in sialocomplexes of the five species, while hexamerin, heat shock protein and histone were identified in sialocomplexes of four species. Salivary proteins related to triatomine immunity as well as those required during blood feeding process such as apyrases, antigen 5, procalins, and nitrophorins compose different complexes. Furthermore, unique proteins for each triatomine species were revealed. This study represents the first Triatominae sialocomplexome reference to date and shows that the approach used is a reliable tool for the analysis of Triatominae salivary proteins assembled into complexes.