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Background: COVID-19 has been troublesome for families due to its socio-economic changes worldwide. Therefore, the present study aimed to investigate the socio-economic burden of COVID-19 on children’s health in Iran.Methods: In the present cross-sectional study, the target population was 500 parents of children aged 5 to 18 years from 5 provinces of Iran in 2021. The samples were randomly selected from different geographical regions of Iran. The questionnaires on the socioeconomic burden of COVID-19, general health, child health, and place of residence landscape were employed to collect the data. For data analysis, t-test, structural equation modeling (SEM) were used in SPSS version 26 and AMOS version 26, respectively.Results: The results indicated that based on determination coefficients of socio-economic burden of COVID-19, the socioeconomic status of the parents and the settlement external perspective variable account for nearly 25% of the mental changes in parents. Furthermore, the combined effects of COVID-19’s socioeconomic burden and parents’ mental health accounted for 26% of the health changes observed in children. The socio-economic burden had a negative correlation with parents’ mental health (β=-0.383, P

Background Ariidae species play a significant role as fishing resources in the Amazon region. However, the family’s systematic classification is notably challenging, particularly regarding species delimitation within certain genera. This difficulty arises from pronounced morphological similarities among species, posing obstacles to accurate species recognition. Methods Following morphological identification, mitochondrial markers (COI and Cytb) were employed to assess the diversity of Ariidae species in the Amazon. Results Our sampling efforts yielded 12 species, representing 92% of the coastal Amazon region’s diversity. Morphological identification findings were largely corroborated by molecular data, particularly for species within the Sciades and Bagre genera. Nonetheless, despite morphological support, Cathorops agassizii and Cathorops spixii displayed minimal genetic divergence (0.010). Similarly, Notarius quadriscutis and Notarius phrygiatus formed a single clade with no genetic divergence, indicating mitochondrial introgression. For the majority of taxa examined, both COI and Cytb demonstrated efficacy as DNA barcodes, with Cytb exhibiting greater polymorphism and resolution. Consequently, the molecular tools utilized proved highly effective for species discrimination and identification.

The Chilean meagre, Cilus gilberti, emerges as a novel species to South American aquaculture. Nevertheless, the successful establishment of its cultivation necessitates careful consideration of productive parameters and tolerance to abiotic stressors. To address these challenges, the identifications of biomarkers emerges as a promising approach. Indeed, leptin stands out as a potential biomarker, given its multifaceted role. This study focuses on characterizing leptin in C. gilberti (cgLep) and assessing its gene expression in juveniles exposed to different culture and feeding conditions. The results indicated that cgLep coding sequence yields a 137-amino acid prohormone, preserving high relevant cysteine residues for maintaining its structural integrity. Basal cgLep gene expression profiles reveal its expression mainly in the liver, followed by white muscle. Conversely, its receptor (cgLepR) exhibits higher levels in white muscle. Additionally, it was observed that juveniles in a postprandial state exhibited an upregulation of hepatic cgLep. Simultaneously, the cgLepR showed a significant increase at brain level during the preprandial stage. The exposure to acute hypoxia revealed a notable upregulation of cgLep after two hours of low oxygen availability and returned to normoxia baseline after six hours post-hypoxia. Notably, when subjected to a prolonged daily hypoxia regimen, no significant differences in leptin mRNA expression were observed. This suggests a dynamic adaptive response of the C. gilberti leptin system to hypoxia. Finally, juvenile Chilean meagre cultivated at 15 Kg/m3 showcase significant individual variability in hepatic leptin expression levels when compared to those cultured at 25 or 35 kg/m3. These observations highlight that leptin primarily expresses in the liver and its expression is notably influenced by fasting periods and chronic stress induced by low stock density. This variability in leptin expression could potentially impact food intake, emphasizing the importance of considering these factors in the design and implementation of aquaculture practices for Chilean meagre.

Abstract The Tambaqui is one of the most representative Amazon fish species, being highly exploited in fisheries, aquaculture and as a research model. Nonetheless, data about functional genome are still required to evaluate reproductive and nutrition parameters as well as resistance to pathogens. The of next-generation sequencing has allows assessing the transcriptional processes in non-model species by providing comprehensive gene collections to be used as a database in further genomic applications and increased performance of captive populations. In this study, we relied on RNAseq approach to generate the first transcriptome of the telencephalon from adult males and females of Colossoma macropomum, resulting in a reference dataset for future functional studies. We retrieved 896,238 transcripts, including the identification of 267,785 contigs and 203,790 genes. From this total, 91 transcripts were differentially expressed, being 63 and 28 of them positively regulated for females and males, respectively. The functional annotation resulted in a library of 40 candidate genes for females and 20 for males. The functional enrichment classes comprised reproductive processes (GO:0,048,609; GO:0,003,006; GO:0,044,703; GO:0,032,504; GO:0,019,953) being related to sex differentiation (e.g., SAFB) and immune response (e.g., SLC2A6, AHNAK, NLRC3, NLRP3 and IgC MHC I alpha3), thus indicating that the genes in the neurotranscriptome of Tambaqui participate in sex differentiation and homeostasis of captive specimens. These data are useful to design the selection of genes related to sex determination and animal welfare in raising systems of Tambaqui.

Abstract Background Standard cancer treatments show a lack of selectivity that has led to the search for new strategies against cancer. The selective elimination of cancer cells modulating the redox environment, known as “selective oxycution”, has emerged as a viable alternative. This research focuses on characterizing the unexplored Escallonia genus plant extracts and evaluating their potential effects on cancer’s redox balance, cytotoxicity, and activation of death pathways. Methods 36 plant extracts were obtained from 4 different species of the Escallonia genus (E. illinita C. Presl, E. rubra (Ruiz & Pav.) Pers., E. revoluta (Ruiz & Pav.) Pers., and E. pulverulenta (Ruiz & Pav.) Pers.), which were posteriorly analyzed by their phytoconstituents, antioxidant capacity, and GC-MS. Further, redox balance assays (antioxidant enzymes, oxidative damage, and transcription factors) and cytotoxic effects (SRB, ∆Ψmt, and caspases actives) of those plant extracts were analyzed on four cell lines (HEK-293T, MCF-7, HT-29, and PC-3). Results 36 plant extracts were obtained, and their phytoconstituents and antioxidant capacity were established. Further, only six extracts had EC50 values

Abstract This study aimed to identify the teleost fish species sold in Bragança, a major fishing hub on the north coast of Brazil. The COI gene analysis was performed for the identification of fish species. The local market uses common names that are not accurate and do not reflect the diversity of the species. 204 sequences were obtained, with 119 haplotypes. 83 species were identified by comparing with public databases and constructing phylogenetic trees, with Carangidae being the most prevalent family. The study also found Haemulon atlanticus, Menticirrhus cuiaranensis and Hoplias misioneira, a newly described species from the Amazon basin, among the samples. Additionally, 73 commercial names were recorded, including 10 categories, and the illegal trade of Epinephelus itajara was detected. The DNA Barcode method proved to be effective for discriminating the species. The study highlights that common and commercial names are vague and underestimate the fish diversity, and that Brazil needs to revise its regulations for commercial and scientific names.

Road network connectivity determines the accessibility of urban activities for pedestrians, while streetscape characteristics have an impact on route attractiveness. Methods used to measure the influence of connectivity and streetscape characteristics on walking behavior differ substantially, while trip purpose is a key factor. This paper explores the respective contributions of network connectivity and streetscape features to explain leisure walking and utilitarian trips on 740 street segments in Santarém (Portugal). The indicators cover the most commonly used factors in walkability indexes, such as density, diversity, design, and accessibility. The streetscape features measure imageability, enclosure, human scale, transparency, and complexity. The walking trip information was collected via survey. The results show that connectivity measures have a greater overall explanatory power for both trip motives. However, the findings highlight the need to consider a variety of design indicators to explain walking behavior due to the higher explanation power of the model with two types of indicators.

BackgroundThe coronavirus disease (COVID-19) pandemic has dramatically changed the health and wellbeing of children. Therefore, this study aimed to investigate the relationship between the home environment and the environmental characteristics on 5–18 years old children health in Iran.MethodAn online survey was conducted among parents of children aged 5 to 18 living in large cities in Iran in 2021. The statistical population of this cross-sectional study was 500 people. In this survey, questionnaires on the quality of the home environment, exterior and interior landscapes of homes, and the Child Health Questionnaire (CHQ) were used to investigate the relationship between the home environment and environmental characteristics on 5–18 years old children health during the COVID-19 pandemic. The t-test and analysis of variance were used in SPSS 24, and the structural equation modeling (SEM) was utilized in AMOS 24 for analyzing the data.ResultsThe average age of respondents was 37.13 ± 7.20, and that of children was 11.57 ± 3.47. 73.02% of the families were covered by insurance, and 74.08% of them lived in the metropolis. In addition, 65.04% of the families complied with the restrictions of the quarantine period. A share of 31% of the families live in villas, and 55% paid more attention to cleaning their homes during the COVID-19 pandemic than before. A positive and significant statistical relationship (β = 0.414, p < 0.001) was observed between the residence environment and child health. Thus, explained 17.5% of variations in child health.ConclusionThe results showed that the children who lived in homes with an exterior landscape in nature had better health. In addition, the 5–18 years old children whose home landscape was a garden, compared to the other two groups (yard, balcony), had better health. Gardens are a potential source of health and not necessarily replaced by other natural environments, thus providing them along with green space is one of the crucial issues that should be considered.

The efficiency of the DNA barcoding relies on sequencing fragment of the Cytochrome C Subunit I (COI) gene, which has been claimed as a tool to biodiversity identification from distinct groups. Accordingly, the goal of this study was to identify juvenile fish species along an estuary of Caeté River in the Brazilian Blue Amazon based on. For this purpose, we applied the DNA barcoding and discuss this approach as a tool for discrimination of species in early ontogenetic stages. A 500-bp fragment was obtained from 74 individuals, belonging to 23 species, 20 genera, 13 families and seven orders. About 70% of the 46 haplotypes revealed congruence between morphological and molecular species identification, while 8% of them failed in identification of taxa and 22% demonstrated morphological misidentification. These results proved that COI fragments were effective to diagnose fish species at early life stages, allowing identifying all samples to a species-specific status, except for some taxa whose COI sequences remain unavailable in public databases. Therefore, we recommend the incorporation of DNA barcoding to provide additional support to traditional identification, especially in morphologically controversial groups. In addition, periodic updates and comparative analyses in public COI datasets are encouraged.

Molecular genetic techniques are an effective monitoring tool, but high-quality DNA samples are usually required. In this study, we compared three different protocols of DNA extraction: NaCl (saline); phenol-chloroform and commercial kit (Promega)-from three biological tissues of five individuals of Lutjanus purpureus under two methods of storage. The evaluated items included DNA concentration and purity, processing time and cost, as well as the obtaining of functional sequences. The highest average values of DNA concentration were obtained using the saline procedure and the commercial kit. Pure DNA was only obtained using the saline protocol, evaluated by the ratio of 260/280. The saline and phenol-chloroform protocols were the least expensive methods. The commercial kit costs are counterbalanced by the short time required. The procedure based on phenol-chloroform presented the worst results regarding DNA yield and the time required to perform all steps. The saline and commercial kit protocols showed similar results concerning the amount and quality of extracted DNA. Therefore, the final choice should be based on the available financial resources and the available time for carrying out each procedure of DNA extraction.

Abstract Background Both CMV and Rubella virus infections are associated with the risk of vertical transmission, fetal death or congenital malformations. In Angola, there are no reports of CMV and Rubella studies. Therefore, our objectives were to study the seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women of Luanda (Angola), identify the risk of primary infection during pregnancy and evaluate the socio-demographic risk factors associated with both infections. Methods A prospective cross-sectional study was conducted from August 2016 to May 2017. Specific anti-CMV and anti-Rubella antibodies were quantified by electrochemiluminescence and demographic and clinical data were collected using standardized questionnaire. Bivariate and multivariate logistic regression analysis were used to quantify the effect of clinical and obstetric risk factors on virus seroprevalence. Results We recruited 396 pregnant women aged from 15 to 47. Among them, 335 (84.6%) were immune to both CMV and Rubella virus infections, while 8 (2.0%) had active CMV infection and 4 (1.0%) active RV infection but none had an active dual infection. Five women (1.2%) were susceptible to only CMV infection, 43 (10.9%) to only RV infection, and 1 (0.3) to both infections. Multivariate analysis showed a significant association between Rubella virus infection and number of previous births and suffering spontaneous abortion. Conclusions Overall, this study showed that there is a high prevalence of anti-CMV and anti-Rubella antibodies in pregnant women in Luanda. It also showed that a small but important proportion of pregnant women, about 11%, are at risk of primary infection with rubella during pregnancy. This emphasizes the need for vaccination.

Southern King Crab (SKC) represents an important fishery resource that has the potential to be a natural source of chitosan (CS) production. In tissue engineering, CS is very useful to generate biomaterials. However, CS has a lack of signaling molecules that facilitate cell–substrate interaction. Therefore, RGD (arginine–glycine–aspartic acid) peptides corresponding to the main integrin recognition site in extracellular matrix proteins have been used to improve the CS surface. The aim of this study was to evaluate in vitro cell adhesion and proliferation of CS films synthesized from SKC shell wastes functionalized with RGD peptides. The FTIR spectrum of CS isolated from SKC shells (SKC-CS) was comparable to commercial CS. Thermal properties of films showed similar endothermic peaks at 53.4 and 53.0 °C in commercial CS and SKC-CS, respectively. The purification and molecular masses of the synthesized RGD peptides were confirmed using HPLC and ESI-MS mass spectrometry, respectively. Mouse embryonic fibroblast cells showed higher adhesion on SKC-CS (1% w/v) film when it was functionalized with linear RGD peptides. In contrast, a cyclic RGD peptide showed similar adhesion to control peptide (RDG), but the highest cell proliferation was after 48 h of culture. This study shows that functionalization of SKC-CS films with linear or cyclic RGD peptides are useful to improve effects on cell adhesion or cell proliferation. Furthermore, our work contributes to knowledge of a new source of CS to synthesize constructs for tissue engineering applications.

Abstract Background HIV and HBV infections remain responsible for high rate of morbidity and mortality in many African Countries, affecting women and newborns. This study aims to analyze the spatial pattern of HIV and HBV infections in pregnant women in Luanda, Angola, and the statistical association between HIV and HBV and socio-economic characteristics, hygiene, and health status. Methods Detection of anti-HIV antibodies (total anti-HIV-1, anti-HIV-2 and HIV-1 p24 antigen) and Hepatitis B antigens (HBsAg, HBeAg) and antibodies (anti-HBc Total II, HBc IgM, Anti-HBsT II) was performed by Enzyme Linked Fluorescent Assay (ELFA) in serum samples of 878 pregnant women attended at the Lucrecia Paim Maternity Hospital (LPMH). Data were collected by questionnaire after written consent, and spatial distribution was assessed through a Kernel Density Function. The potential risk factors associated with HIV HBV infection were evaluated using bivariate and multivariate binomial logistic regression analysis. Results Anti-HIV antibodies were positive in 118 samples (13.4%) and HBV infection were positive in 226 (25.7%). The seroprevalence of HIV/HBV coinfection was of 6.3%. The results showed that the seroprevalence of HBV was similar in most municipalities: 25.8% in Belas; 26.6% in Viana; 27.6% in Luanda; 19.2% in Cacuaco; and 15.6% Cazenga. For HIV, the seroprevalence was also close ranges among the municipalities: 10.0% in Belas; 14.5% in Viana 14.9% in Luanda and 12.5% in Cazenga. However, the seroprevalence in municipality of in Cacuaco was lower (5.8%) and bivariate and multivariate analysis showed a lower risk for HIV in this area (OR 0.348, CI 0.083–0.986; OR 0.359, CI 0.085–1.021). The multivariate analysis had also showed a significant increased risk for HIV in women with 2 or 3 births (OR 1.860, CI 1.054–3.372). Conclusions Our results underlined the need to improve the screening and clinical follow-up of HIV and HBV in Angola, as well the educational campaigns to prevent not only the morbidity and mortality associated with these diseases, but also their transmission, mainly in women in reproductive age and pregnant, encouraging the pre-natal consultations in order to avoid mother-to-child transmission.

As a cross-sectoral issue, the promotion of health needs to be addressed across all policies. In Portugal, as more competencies are being transferred to local governments, the integration of health considerations into municipal plans remains a challenge and guidance on how to develop an integrated municipal health strategy is absent. The aim of this study is to describe the conceptual and methodological approach that informed the development of an integrated and multisectoral municipal health strategy in the City of Coimbra. Its design followed a population health approach with a geographic lens, looking at how the population’s health outcomes and health determinants were geographically distributed across the municipality, as well as the extent to which policies from multiple sectors can address them. The planning cycle followed an iterative workflow of five actions: assessing, prioritizing, planning, implementing, and monitoring. Following a participatory planning approach, several participatory processes were conducted involving local stakeholders and citizens (e.g., population-based surveys, workshops, Delphi, collaborative sessions) to identify problems, establish priorities, and define measures and actions. The strategic framework for action integrates 94 actions across multisectoral domains of municipal intervention: sustainable mobility and public places, safe and adequate housing, accessible healthcare, social cohesion and participation, education and health literacy, and intersectoral and collaborative leadership. Findings shed light on important aspects that can inform other municipal strategies, such as the adoption of a place-based approach, focused on geographic inequalities, health determinants and stakeholder participation, and the application of a health in all policies framework.

Abstract Background Non-communicable diseases are a leading cause of health loss worldwide, in part due to unhealthy lifestyles. Metabolic-based diseases are rising with an unhealthy body-mass index (BMI) in rural areas as the main risk factor in adults, which may be amplified by wider determinants of health. Changes in rural environments reflect the need of better understanding the factors affecting the self-ability for making balanced decisions. We assessed whether unhealthy lifestyles and environment in rural neighbourhoods are reflected into metabolic risks and health capability. Methods We conducted a community-based cross-sectional study in 15 Portuguese rural neighbourhoods to describe individuals’ health functioning condition and to characterize the community environment. We followed a qualitatively driven mixed-method design to gather information about evidence-based data, lifestyles and neighbourhood satisfaction (incorporated in eVida technology), within a random sample of 270 individuals, and in-depth interviews to 107 individuals, to uncover whether environment influence the ability for improving or pursuing heath and well-being. Results Men showed to have a 75% higher probability of being overweight than women (p-value = 0.0954); and the reporting of health loss risks was higher in women (RR: 1.48; p-value = 0.122), individuals with larger waist circumference (RR: 2.21; IC: 1.19; 4.27), overweight and obesity (RR: 1.38; p-value = 0.293) and aged over 75 years (RR: 1.78; p-value = 0.235; when compared with participants under 40 years old). Metabolic risks were more associated to BMI and physical activity than diet (or sleeping habits). Overall, metabolic risk linked to BMI was higher in small villages than in municipalities. Seven dimensions, economic development, built (and natural) environment, social network, health care, demography, active lifestyles, and mobility, reflected the self-perceptions in place affecting the individual ability to make healthy choices. Qualitative data exposed asymmetries in surrounding environments among neighbourhoods and uncovered the natural environment and natural resources specifies as the main value of rural well-being. Conclusions Metabolic risk factors reflect unhealthy lifestyles and can be associated with environment contextual-dependent circumstances. People-centred approaches highlight wider socioeconomic and (natural) environmental determinants reflecting health needs, health expectations and health capability. Our community-based program and cross-disciplinary research provides insights that may improve health-promoting changes in rural neighbourhoods.

The ideal treatment for chronic wounds is based on the use of bioactive dressings capable of releasing active agents. However, the control of the rate at which these active agents are released is still a challenge. Bioactive polymeric fiber mats of poly(styrene-co-maleic anhydride) [PSMA] functionalized with amino acids of different hydropathic indices and L-glutamine, L-phenylalanine and L-tyrosine levels allowed obtaining derivatives of the copolymers named PSMA@Gln, PSMA@Phe and PSMA@Tyr, respectively, with the aim of modulating the wettability of the mats. The bioactive characteristics of mats were obtained by the incorporation of the active agents Calendula officinalis (Cal) and silver nanoparticles (AgNPs). A higher wettability for PSMA@Gln was observed, which is in accordance with the hydropathic index value of the amino acid. However, the release of AgNPs was higher for PSMA and more controlled for functionalized PSMA (PSMAf), while the release curves of Cal did not show behavior related to the wettability of the mats due to the apolar character of the active agent. Finally, the differences in the wettability of the mats also affected their bioactivity, which was evaluated in bacterial cultures of Staphylococcus aureus ATCC 25923 and methicillin-resistant Staphylococcus aureus ATCC 33592, an NIH/3T3 fibroblast cell line and red blood cells.

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

Objective: To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. Method: This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. Results: We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. Conclusions: Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders. Resumen: Objetivo: Analizar las desigualdades socioeconómicas en la mortalidad por todas las causas en hombres y mujeres de nueve áreas urbanas europeas durante la reciente crisis económica, y comparar los resultados con dos periodos previos a la crisis. Método: Estudio ecológico de tendencias basado en tres periodos (2000-2003, 2004-2008 y 2009-2014). Las unidades de análisis fueron las áreas pequeñas de nueve zonas urbanas europeas. Se utilizaron un índice compuesto de privación socioeconómica como indicador socioeconómico y otros indicadores simples. Como indicador de mortalidad se usó la razón de mortalidad estandarizada suavizada, calculada utilizando el modelo jerárquico bayesiano propuesto por Besag, York y Mollié. Para analizar la evolución de las desigualdades socioeconómicas se utilizó un modelo de regresión ecológico que incluía el indicador socioeconómico, el periodo y la interacción de ambos. Resultados: Se observaron desigualdades significativas en la mortalidad en los hombres para casi todos los indicadores socioeconómicos, periodos y áreas urbanas. Sin embargo, no hubo cambios significativos en las desigualdades en el periodo de crisis. Aunque las desigualdades entre las mujeres fueron menos comunes, hubo un incremento significativo en las desigualdades en mortalidad en el periodo de crisis en términos de desempleo y del índice de privación en Praga y Estocolmo, respectivamente. Conclusiones: Futuros análisis deberán tener en cuenta el tiempo transcurrido entre la crisis y su efecto en la mortalidad, así como diferentes causas de mortalidad y el efecto diferencial entre géneros.

During the last decades, important efforts have been taken to tackle cardiovascular diseases, which resulted in important mortality and disability decreases. Despite this, cardiovascular diseases are still one of the major causes of death in Portugal. Thus, the aim of this study is to analyse the evolution of the spatial pattern of deaths by cardiovascular diseases, between 1991 and 2017, identifying areas of high risk, and its variation, in the 278 municipalities of Continental Portugal.Secondary data on annual resident population and deaths by cardiovascular diseases (International Classification of Diseases 10th revision: I00-I99) was collected from the Portuguese National Statistics for the municipalities of Portugal Mainland, from the period under analysis.To identify areas with significant high and low risk of mortality by cardiovascular diseases, towards time and space, and areas with significantly high or low temporal trends, retrospective spatial-temporal cluster and a spatial variation in temporal trends analysis were conducted.In the spatial-temporal analysis 3 clusters of high risk and two of low risk were identified; municipalities forming the clusters of high risk tend to have rural characteristics while the municipalities in the clusters of low risk are located in the two metropolitan areas. The majority of the municipalities forming the clusters of low risk also present higher decreasing trends than the country average.The results presented can contribute to support the development of future interventions on cardiovascular mortality.

Abstract Background Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Methods Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. Results The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced – (1) the ‘Failing Europe’ scenario (worst case/increasing inequalities), (2) the ‘Sustainable Prosperity’ scenario (best case/decreasing inequalities) and (3) the ‘Being Stuck’ scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. Conclusions The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.

COVID-19 hit the world in a sudden and uneven way. Scientific community has provided strong evidence about socioeconomic characteristics of the territory associated with the geographical pattern of COVID-19 incidence. Still, the role played by these factors differs between study areas. Geographically Weighted Regression (GWR) models were applied to explore the spatially varying association between age-standardized COVID-19 incidence rate in 2020 and socioeconomic conditions in Portugal, at the municipality level. The spatial context was defined as a function of the number of neighbours; the bandwidth was determined through AIC. Prior, the validity of the GWR was assessed through ordinary least squares models. Border proximity, proportion of overcrowded living quarters, persons employed in manufacturing establishments and persons employed in construction establishments were found to be significant predictors. It was possible to observe that municipalities are affected differently by the same factor, and that this varying influence has identifiable geographical patterns, the role of each analysed factor varies importantly across the country. This study provides useful insights for policymakers for targeted interventions and for proper identification of risk factors.

Elasmobranchs represent a well-defined group, composed of about 1,150 species inhabiting diverse aquatic environments. Currently, several of these species have been classified as threaten due to overexploitation. Therefore, we used DNA barcode to identify traded species of sharks and stingrays in the municipality of Bragança (Amazon coastal region), a major fishery landing site in northern Brazil. We collected a total of 127 samples labeled into 24 commercial nomenclatures over 1-year period. Twenty species were discriminated and 13 of them are recognized under some threatening status. In relation to sharks, Carcharhinidae showed the highest number of species, half of them classified as endangered, followed by hammerhead sharks (Sphyrnidae), with four species also regarded as threatened with extinction. The Rhinopteridae and Dasyatidae rays were the most abundant groups, with trade records of the following threatened species: Rhinoptera brasiliensis, Rhinoptera bonasus, Hypanus berthalutzae, and Fontitrygon geijskesi. It is noteworthy that threatened species of elasmobranchs have been frequently and regularly exploited because of inefficient fishery management policies. Therefore, effective inspection practices need to be incorporated in fisheries, including the use of DNA barcode to enable a reliable method of species authentication and to assure the proper commercialization.

The study of premature deaths from causes that are generally preventable given the current availability of healthcare – called amenable deaths due to healthcare – provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007–2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists.A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education.Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training.These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.

Evidência científica indica que a obesidade é responsável por diversas doenças crónicas, como são exemplo a hipertensão e a diabetes mellitus tipo 2. Recentemente, a literatura tem vindo a chamar a atenção para o facto de indivíduos com obesidade apresentarem risco mais elevado de desenvolver sintomas graves da Covid-19. Ser ativo é visto como medida positiva para prevenir e tratar doenças como hipertensão e diabetes, entre outras. A forma das cidades, a distribuição dos equipamentos e o desenho urbano podem influenciar positivamente (ou negativamente) o modo como as pessoas se deslocam e se relacionam com o ambiente da área de residência, aumentando (ou diminuindo) os níveis de atividade física e, potencialmente, contrariando o sedentarismo. Este estudo, realizado em Coimbra, investigou: i) a associação estatística entre as tipologias de uso do solo e as condições do ambiente físico e construído em que os indivíduos vivem; ii) o papel desempenhado pelas condições ambientais no excesso de peso e obesidade. Foi recolhida informação de 1 117 indivíduos residentes em freguesias urbanas, periurbanas e rurais, entre março e setembro de 2020. Com estes dados foram desenvolvidos modelos de regressão logística binomial, ajustados por sexo e idade. Os resultados permitem concluir que os residentes mais afastados do centro da cidade (áreas periurbanas e rurais) apresentam maior probabilidade de terem excesso de peso, de usarem automóvel, de avaliarem positivamente aspetos relacionados com os serviços urbanos (e.g. espaços públicos de lazer e as áreas verdes urbanas) e a qualidade do ar. Residentes periurbanos que usam transporte público têm menor probabilidade de ter excesso de peso em relação a quem utiliza o automóvel. Identificar ambientes obesogénicos é uma condição fundamental para a construção de políticas públicas que tenham como objetivo a promoção da saúde, a prevenção da doença e a redução das iniquidades.

O objetivo deste estudo foi avaliar o contributo do ambiente construído, entre outros fatores, no excesso de peso, em Portugal, utilizando como amostra a Rede Portuguesa de Municípios Saudáveis (RPMS). Foi aplicado um estudo transversal com inquérito de base populacional, realizado entre maio/2020-abril/2021, com uma amostra de 10.047 indivíduos adultos (≥18 anos). Dados antropométricos, consumo alimentar, autoavaliação de saúde e condições de saúde foram autorreportadas. Foram, ainda, incluídas as prevalências de Diabetes Mellitus-DM e de Hipertensão Arterial Sistémica-HAS, pelo diagnóstico médico prévio. O excesso de peso foi avaliado pelo Índice de Massa Corporal ≥25kg/m2, tendo sido associado às condições: (i) individuais (demográficos/socieconómicas/saúde/comportamentais) e (ii) do contexto da área de residência (disponibilidade de equipamentos desportivos/lazer/recreação; acesso a espaços verdes e a lojas de alimentos). Para isso, foram realizadas regressões logísticas, ajustada pela idade e sexo. O excesso de peso variou entre 37,5 e 48%, sendo mais prevalente na população residente em municípios rurais, apresentando associação estatisticamente significativa em indivíduos com uma pior avaliação do estado de saúde, HAS e DM, que não praticam atividade física, com pior condição socioeconómica, que não consumiam diariamente frutas e legumes e com consumo frequente de enchidos e refrigerantes. Condições do ambiente construído também se associaram ao excesso de peso nos municípios de média dimensão (com população entre 30 a 80 mil habitantes e entre 80 a 150 mil habitantes). Os resultados mostram a importância do combate à obesidade com base na tipologia territorial.

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

Abstract Background Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and better cope with fast evolving challenges. Objective This paper describes the three 2030 time-horizon scenarios developed under the EURO-HEALTHY project, depicting the key factors that may affect the evolution of PH inequalities across European regions. Methods A three-stage socio-technical approach was applied: i) identification of drivers (key factors expected to affect the evolution of PH inequalities across European regions until 2030) – this stage engaged in a Web-Delphi process a multidisciplinary panel of 51 experts and other stakeholders representing the different perspectives regarding PH inequalities; ii) generation of scenario structures – different drivers’ configurations (i.e. their hypotheses for evolution) were organized into coherent scenario structures using the Extreme-World Method; and iii) validation of scenario structures and generation of scenario narratives. Stages ii) and iii) were conducted in two workshops with a strategic group of 13 experts with a wide view about PH inequalities. The scenario narratives were elaborated with the participants’ insights from both the Web-Delphi process and the two workshops, together with the use of evidence (both current and future-oriented) on the different areas within the PH domain. Results Three scenarios were developed for the evolution of PH inequalities in Europe until 2030: ‘Failing Europe’ (worst-case but plausible picture of the future), ‘Sustainable Prosperity’ (best-case but plausible picture of the future), and an interim scenario ‘Being Stuck’ depicting a ‘to the best of our knowledge’ evolution. These scenarios show the extent to which a combination of Political, Economic, Social, Technological, Legal and Environmental drivers shape future health inequalities, providing information for European policy-makers to reflect upon whether and how to design robust policy solutions to tackle PH inequalities. Conclusions The EURO-HEALTHY scenarios were designed to inform both policy design and appraisal. They broaden the scope, create awareness and generate insights regarding the evolution of PH inequalities across European regions.

Abstract Background There has been increasing interest in assessing the impacts of extreme temperatures on mortality due to diseases of the circulatory system. This is further relevant for future climate scenarios where marked changes in climate are expected. This paper presents a solid method do identify the relationship between extreme temperatures and mortality risk by using as predictors simulated temperature data for cold and hot conditions in two urban areas in Portugal. Methods Based on the mortality and meteorological data from Porto Metropolitan Area (PMA) and Lisbon Metropolitan Area (LMA), a distributed lag nonlinear model (DLNM) was implemented to estimate the temperature effects on mortality due to diseases of the circulatory system. The performance of the models was validated via bootstrapping approaching by creating resamples with replacement from the validating data. Bootstrapping was also used to identify the best candidate model and to evaluate the sensitivity of the spline functions to the exposure-lag-response relationship. Results It is found that the model is able to reproduce the temperature-related mortality risk for two metropolitan areas. Temperature previously simulated by climate models is useful and even better than observed temperature. Although, the biases in predictions in both metropolitan areas are low, mortality risk predictions in PMA are more accurate than in LMA. Using parametric bootstrapping, we found that the overall cumulative association estimated under different bi-dimensional exposure-lag-response relationship are relatively stable, especially for the model selected by Quasi-Akaike Information Criteria (QAIC). Exposure to summer temperature conditions is best related to mortality risk. The association between winter temperature and mortality risk is somewhat less strong. Conclusions The use of QAIC to choose from several candidate models provides valid predictions and reduced the uncertainty in the estimated relative risk for circulatory disease mortality. Our findings can be applied to better understand the characteristics and facilitate the prevention of circulatory disease mortality in Porto and Lisbon Metropolitan Areas, namely if we consider the actual context of climate change.

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

Nas políticas de educação, a partir dos anos 2000, observa-se aproximação do Investimento Social Privado (ISP), buscando o aumento da qualidade da educação através das colaborações e do foco nos resultados, com destaque para as avaliações dentro do sistema. Mas, embora haja influência do ISP, o campo tem sido marcado pela atuação de uma multiplicidade de atores e múltiplas lógicas institucionais, ligadas à atuação estatal, profissional e do mercado, que se tornam mais proeminentes na medida em que se observam contextos locais de implementação. No nível da implementação da política pública, os contextos são mais diversos, caracterizando este ambiente como de alta complexidade institucional. Na interação das ações diretas do ISP nos projetos de fortalecimento de gestão diferenciam-se os profissionais da educação e os gestores educacionais. No contexto de realização dos projetos, foram observadas práticas que buscam aumentar a compatibilidade de lógicas, principalmente nas interações entre profissionais de ISP e gestores educacionais e na forma de escolha e estruturação de projetos por parte do ISP.

Abstract Background In accordance the WHO framework of health system functions and by using the indicators collected within the EURO-HEALTHY project, this work aims to contribute to the discussion on the classification of EU health systems. Methods Three methods were used in this article: factor analysis, cluster analysis and descriptive analysis; data were mainly collected from the WHO and Eurostat databases. Results The most relevant result is the proposed classification of health systems into the following clusters: Austria-Germany, Central and Northern Countries, Southern Countries, Eastern Countries ‘A’ and Eastern Countries ‘B’. Conclusions The proposed typology contributes to the discussion about how to classify health systems; the typology of EU health systems allows comparisons of characteristics and health system performance across clusters and policy assessment and policy recommendation within each cluster.

Abstract Background Indicators are essential instruments for monitoring and evaluating population health. The selection of a multidimensional set of indicators should not only reflect the scientific evidence on health outcomes and health determinants, but also the views of health experts and stakeholders. The aim of this study is to describe the Delphi selection process designed to promote agreement on indicators considered relevant to evaluate population health at the European regional level. Methods Indicators were selected in a Delphi survey conducted using a web-platform designed to implement and monitor participatory processes. It involved a panel of 51 experts and 30 stakeholders from different areas of knowledge and geographies. In three consecutive rounds the panel indicated their level of agreement or disagreement with indicator’s relevance for evaluating population health in Europe. Inferential statistics were applied to draw conclusions on observed level of agreement (Scott’s Pi interrater reliability coefficient) and opinion change (McNemar Chi-square test). Multivariate analysis of variance was conducted to check if the field of expertise influenced the panellist responses (Wilk’s Lambda test). Results The panel participated extensively in the study (overall response rate: 80%). Eighty indicators reached group agreement for selection in the areas of: economic and social environment (12); demographic change (5); lifestyle and health behaviours (8); physical environment (6); built environment (12); healthcare services (11) and health outcomes (26). Higher convergence of group opinion towards agreement on the relevance of indicators was seen for lifestyle and health behaviours, healthcare services, and health outcomes. The panellists’ field of expertise influenced responses: statistically significant differences were found for economic and social environment (p

Introduction: Suicide is considered a public health priority. It is a complex phenomenon resulting from the interaction of several factors, which do not depend solely on individual conditions. This study analyzes the spatio-temporal evolution of suicide mortality between 1980 and 2015, identifying areas of high risk, and their variation, in the 278 municipalities of Continental Portugal. Material and Methods: Based on the number of self-inflicted injuries and deaths from suicide and the resident population, the spatio-temporal evolution of the suicide mortality rate was assessed via: i) a Poisson joinpoint regression model, and ii) spatio-temporal clustering methods. Results: The suicide mortality rate evolution showed statistically significant increases over three periods (1980 - 1984; 1999 - 2002 and 2006 - 2015) and two statistically significant periods of decrease (1984 - 1995 and 1995 - 1999). The spatio-temporal analysis identified five clusters of high suicide risk (relative risk >1) and four clusters of low suicide risk (relative risk < 1). Discussion: The periods when suicide mortality increases seem to overlap with times of economic and financial instability. The geographical pattern of suicide risk has changed: presently, the suicide rates from the municipalities in the Center and North are showing more similarity with those seen in the South, thus increasing the ruralization of the phenomenon of suicide. Conclusion: Between 1980 and 2015 the spacio-temporal pattern of mortality from suicide has been changing and is a phenomenon that is currently experiencing a growing trend (since 2006) and is of higher risk in rural areas.

Abstract Background The recent economic and financial crisis in Portugal urged the Portuguese Government in April 2011 to request financial assistance from the troika austerity bail out program to get aid for its government debt. The troika agreement included health reforms and austerity measures of the National Health Service (NHS) in Portugal to save non-essential health care costs. This research aimed to identify potential barriers among the elderly population (aged 65 and above) to healthcare access influenced by the economic crisis and the troika agreement focussing on the Memorandum of Understanding on Specific Economic Policy Conditionality (MoU) in Lisbon metropolitan area, Portugal. Methods The qualitative study is including 13 semi-structured interviews of healthcare experts, municipality authority, health care providers, negotiator of the troika agreement, hospital managers, health economists and elderly. A content analysis was performed to evaluate the interviews applying Nvivo2011 software. The barriers identified were clustered towards the five areas of the ‘Conceptual framework on health care access’ by Levesque et al. (Int J Equity Health 12:18, 2013). Results Healthcare access for the elderly was found inadequate in four areas of the framework: availability; appropriateness; approachability; and affordability. The fifth area on acceptability was not identified since the study neither followed a gender nor ethnic specific purpose. The main identified barriers were: current financial situation and pension cuts; insufficient provision and increased user fees in primary care; inadequate design and availability of hospital care service; lack of long-term care facilities; increased out-of-pocket-payment on pharmaceuticals; limitations in exemption allowances; cuts in non-emergent health transportation; increased waiting time for elective surgery; and poor unadapted housing conditions for elderly. Conclusions The health reforms and health budget cuts in the MoU implemented as part of the troika agreement have been associated with increasing health inequalities in access to healthcare services for the elderly population. The majority of responses disclosed an increasing deficiency across the entire National Health Service (NHS) to collaborate, integrate and communicate between the different healthcare sectors for providing adequate care to the elderly. An urgent necessity of restructuring the health care system to adapt towards the elderly population was implied.

Abstract Background Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000–2014), and their associated financial burden. Methods We modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000–2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators. Results Hospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p

Abstract Background The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010. Methods Nationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30–64 years. Results A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women. Conclusion The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.

Abstract This study’s aims are: (i) identifying spatial patterns for the risk of hospitalization due to mental illness and for the potential risk resulting from contextual factors with influence on mental health; and (ii) analyzing the spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors in the metropolitan areas of Lisbon and Porto, Portugal. A cross-sectional ecological study was conducted by applying statistical methods for assessing spatial dependency and heterogeneity. Results reveal a spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors with a statistical relevance of moderate intensity. 20% of the population under study lives in areas with a simultaneously high potential risk resulting from contextual factors and risk of hospitalization due to mental illness. Porto Metropolitan Area show the highest percentage of population living in parishes with a significantly high risk of hospitalization due to mental health, which puts forward the need for interventions on territory-adjusted contextual factors influencing mental health.

Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.

Several studies emphasize that temperature-related mortality can be expected to have differential effects on different subpopulations, particularly in the context of climate change. This study aims to evaluate and quantify the future temperature-attributable mortality due to circulatory system diseases by age groups (under 65 and 65+ years), in Lisbon metropolitan area (LMA) and Porto metropolitan area (PMA), over the 2051−2065 and 2085−2099 time horizons, considering the greenhouse gas emissions scenario RCP8.5, in relation to a historical period (1991−2005). We found a decrease in extreme cold-related deaths of 0.55% and 0.45% in LMA, for 2051−2065 and 2085−2099, respectively. In PMA, there was a decrease in cold-related deaths of 0.31% and 0.49% for 2051−2065 and 2085−2099, respectively, compared to 1991−2005. In LMA, the burden of extreme heat-related mortality in age group 65+ years is slightly higher than in age group

Climate change is now widely recognised as the greatest global threat over the coming decades. This study aimed to quantify and project the effects of climate change on future temperature-attributable mortality due to circulatory system diseases (CSD) in Lisbon metropolitan area (LMA) and in Porto metropolitan area (PMA). The future time slices of Representative Concentration Pathway (RCP 8.5), mid-term (2046−2065) and long-term (2080−2099) were compared with the reference period (1986−2005). There is a significant decreasing trend in proportion to the overall extreme cold temperature-attributable mortality due to CSD in the future periods (2045−2065 and 2081−2099) in LMA, −0.63% and −0.73%, respectively, and in PMA, −0.62% for 2045−2065 and −0.69% for 2081−2099, compared to the historical period. The fraction attributable to extreme hot temperature in the summer months increased by 0.08% and 0.23%, from 0.04% in the historical period to 0.11% during 2046−2065, and to 0.27% during 2081−2099 in LMA. While there were no noticeable changes due to extreme hot temperature during the summer in PMA, significant increases were observed with warmer winter temperatures: 1.27% and 2.80%. The projections of future temperature-attributable mortality may provide valuable information to support climate policy decision making and temperature-related risk management.

O planejamento e a gestão de políticas para enfrentamento das mudanças climáticas exigem por parte de diferentes atores mediados pelo Estado, adoção de estratégias de adaptação e mitigação, políticas que envolvem setores distintos e interferem no uso/ocupação/transformação do solo urbano. Admitindo a relevância da legislação como elemento estruturador do processo de implementação de políticas públicas, realizou-se avaliação legislativa das normas jurídicas de políticas urbana e climática de alguns municípios integrantes da Região Metropolitana de São Paulo. O artigo narra o processo metodológico de construção de Instrumento de Análise a partir de elenco de categorias teóricas. O método colocou em destaque a fragilidade da questão metropolitana e evidenciou que, embora haja respaldo legal para a estruturação da gestão integrada, o suporte para a concretização dessa gestão se dará com o avanço efetivo na organização das estruturas regionais de planejamento e gestão de políticas sob a lógica do ordenamento territorial.

Exposure to cold weather has negative consequences on human health. Studies have been showing that the seasonality of mortality has an evident peak during winter months in European countries. However, the highest increases in mortality are registered in countries with mild winters. According to several studies winter deaths seem to be associated with low socioeconomic conditions. The main aims of this study are to identify the trends of mortality due to diseases of the circulatory system and excess winter deaths in Portugal and to assess the geographical pattern of seasonal mortality. In the 20 years under analyses, mortality due to diseases of the circulatory system increased 38% during winter months when compared to the non-winter period. Important regional disparities were found, the Excess Winter Death index ranged from 21% to 48%, the central regions tend to have better results. Our results indicate that although circulatory mortality is significantly decreasing inPortugal, the vulnerability to seasonal cold weather remains as an important public healthissue. These findings suggest that the exposure to cold weather is an important determinantof cardiovascular diseases that is still neglected in Portugal.

A prematuridade é um dos grandes problemas de saúde pública, contribuindo fortemente para a morbi-mortalidade infantil, tanto em países em desenvolvimento como o Brasil, quanto em países europeus como Portugal. O nascido prematuro é aquele que nasce com menos de 37 semanas de gestação. Os fatores de risco individuais associados à incidência da prematuridade são conhecidos. No entanto, os fatores contextuais que podem influenciar a sua incidência têm sido pouco estudados. O principal objetivo deste estudo foi identificar o padrão espacial do risco relativo de nascimento pré-termo e possíveis agrupamentos espaciais, assim como examinar se as condições socioeconômicas estão espacialmente associadas com o risco relativo de nascimento pré-termo em duas áreas metropolitanas: Região Metropolitana de São Paulo (RMSP), no Brasil, e Área Metropolitana de Lisboa (AML), em Portugal. Foi recolhida informação relativa aos nascidos vivos (2000-2010) de mães residentes em ambas as áreas metropolitanas e às condições socioeconômicas das mães. Para análise de associação espacial entre o risco relativo de nascimentos pré-termo e as variáveis do contexto geográfico, foram aplicados testes de associação espacial global (I Moran) para ambas as áreas metropolitanas. A distribuição geográfica do risco relativo de nascimentos pré-termo ocorreu de maneira não aleatória e heterogênea tanto na RMSP como na AML: na RMSP verificou-se existir uma associação espacial global negativa significativa entre risco relativo e taxa de desemprego; na AML, foi revelada associação global positiva significativa entre o risco relativo e a taxa de analfabetismo, o índice de privação sóciomaterial e a da taxa de desemprego.

Distance patients have to travel has shown to influence demand for several health services. Our work looks at this effect on the utilization of Emergency Departments (ED) in Portugal. We build upon previous works by taking into account both the severity of emergency visits and the type of ED and by including a set of other variables that have shown to influence ED utilization. Overall, we find distance-elasticity for emergency care that ranges from -1 to -2 (a 10% increase in distance to ED results in a 10-20% decrease in ED utilization), with low-severity demand having the highest distance-elasticity and high-severity demand the lowest. We also show that Primary Health Care, and particularly some new typology of health centers in Portugal, negatively affects ED utilization. Our results provide evidence that distance enters in the budget constraints patients face when seeking health care.

BACKGROUND:Intestinal parasitic infections remain among the most common infectious diseases worldwide. This study aimed to estimate their prevalence and provide a detailed analysis of geographical distribution of intestinal parasites in the metropolitan region of Rio de Janeiro, considering demographic, socio-economic, and epidemiological contextual factors. METHODS/PRINCIPAL FINDINGS:The cross-section survey was conducted among individuals attending the Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ, RJ) during the period from April 2012 to February 2015. Stool samples were collected and processed by sedimentation, flotation, Kato-Katz, Baermann-Moraes and Graham methods, iron haematoxylin staining and safranin staining. Of the 3245 individuals analysed, 569 (17.5%) were infected with at least one parasite. The most common protozoa were Endolimax nana (28.8%), Entamoeba coli (14.8%), Complex Entamoeba histolytica/Entamoeba dispar (13.5%), Blastocystis hominis (12.7%), and Giardia lamblia (8.1%). Strongyloides stercoralis (4.3%), Schistosoma mansoni (3.3%), Ascaris lumbricoides (1.6%), and hookworms (1.5%) were the most frequent helminths. There was a high frequency of contamination by protozoa (87%), and multiple infections were observed in 141 participants (24.8%). A positive association between age (young children) and gender (male) with intestinal parasites was observed. Geospatial distribution of the detected intestinal parasitic infections was not random or homogeneous, but was influenced by socioeconomic conditions (through the material deprivation index (MDI)). Participants classified in the highest levels of deprivation had higher risk of having intestinal parasites. CONCLUSIONS/SIGNIFICANCE:This study provides the first epidemiological information on the prevalence and distribution of intestinal parasitic infections in the Rio de Janeiro metropolitan area. Intestinal parasites, especially protozoa, are highly prevalent, indicating that parasitic infections are still a serious public health problem. MDI showed that intestinal parasites were strongly associated with the socioeconomic status of the population, thus making it possible to identify social vulnerable areas.

ACCESSIBILITY AND USE OF URBAN GREEN SPACES IN THE CITIES OF COIMBRA (PORTUGAL) AND SALAMANCA (SPAIN). In a society that values more and more wellbeing, health and free time, the introduction of urban green spaces (UGS) next to residential areas has become a citizen’s right and requirement. This paper analyses the distribution and accessibility of UGS in the cities of Coimbra and Salamanca and evaluates their influence on the needs of the resident populations, in terms of users’ age, frequency of usage, as well as of motivation and ways to enjoy the facilities. In Coimbra there is a concentration of UGS, whereas in Salamanca there is a dispersion of such spaces, which has resulted in the different usage that people make of them. In fact, although Coimbra offers more urban green space (per inhabitant), their usage is reduced as people go there mainly by car, contrary to what happens in Salamanca. Consequently, Coimbra’s inhabitants choose these green spaces because of the activities they can be used for, whereas Salamanca’s inhabitants choose them for their proximity.

Data from epidemiological studies suggest that prenatal exposure to bacterial and viral infection is an important environmental risk factor for schizophrenia. The maternal immune activation (MIA) animal model is used to study how an insult directed at the maternal host can have adverse effects on the fetus, leading to behavioral and neurochemical changes later in life. We evaluated whether the administration of LPS to rat dams during late pregnancy affects astroglial markers (S100B and GFAP) of the offspring in later life. The frontal cortex and hippocampus were compared in male and female offspring on postnatal days (PND) 30 and 60. The S100B protein exhibited an age-dependent pattern of expression, being increased in the frontal cortex and hippocampus of the MIA group at PND 60, while at PND 30, male rats presented increased S100B levels only in the frontal cortex. Considering that S100B secretion is reduced by elevation of glutamate levels, we may hypothesize that this early increment in frontal cortex tissue of males is associated with elevated extracellular levels of glutamate and glutamatergic hypofunction, an alteration commonly associated with SCZ pathology. Moreover, we also found augmented GFAP in the frontal cortex of the LPS group at PND 30, but not in the hippocampus. Taken together data indicate that astroglial changes induced by MIA are dependent on sex and brain region and that these changes could reflect astroglial dysfunction. Such alterations may contribute to our understanding of the abnormal neuronal connectivity and developmental aspects of SCZ and other psychiatric disorders.

Este artigo insere-se na temática das comunidades sustentáveis, procurando atribuir às características (físicas e imateriais) do ambiente local um papel explicativo na génese e manutenção das variações geográficas em saúde pública. Considerando um dos maiores problemas de saúde pública dos países desenvolvidos – obesidade e excesso de peso – e utilizando um modelo de regressão logística binomial, procura-se avaliar o impacte dos atributos ambientais, para além do impacte dos atributos individuais, no índice de massa corporal (IMC) de uma população urbana. Conclui-se que na Área Metropolitana de Lisboa, o risco de possuir excesso de peso/obesidade depende tanto de características individuais – por exemplo, género e idade – como de características ambientais, nomeadamente das oportunidades dos lugares e do seu nível de privação social e material.

Infant mortality has declined in Brazil in recent years, partly as a result of increased Primary Health Care (PHC) coverage and better access to it. However, there are still enormous regional inequalities in these indicators, and therefore spatial variations in infant mortality. In a country like Brazil that is of continental proportions, it is important to analyse/assess health policies in the context of regional inequalities in order to ensure equity. This study thus aims to analyse the regional impacts of PHC and assess the importance of socioeconomic contexts upon infant mortality rates (IMRs) in the state of Minas Gerais. This is the fourth biggest state in Brazil, with a population of almost 20 million, distributed over 66 microregions. The IMR was assessed for the periods 2002-2006 and 2007-2011 in the 66 microregions, considering three operative dimensions:i. indexes of families aided by PHC;ii. indexes of prenatal care;iii. and the Index of Sociomaterial Deprivation (ISD).The data were collected from secondary official sources, and modelled on temporal and spatial scales defined and worked in a Geographical Information System. The ISD, which is a composite indicator used to express social and regional inequalities, was constructed on the basis of three indicators: i) illiteracy; ii) wages; and iii) homes without indoor bathrooms. The results showed a reduction in IMR in almost all the microregions of Minas Gerais between 2002-2006 and 2007-2011. However, there were inequalities in this decrease, with a continuing concentration of mortality in microregions with higher ISD. The expansion of PHC is more marked in the microregions with higher ISD, which is a positive sign from the Brazilian Health System. However, the expansion of these services as an isolated sectorial policy, though important, has not on its own been able to reduce the geographical inequalities in infant mortality in Minas Gerais. Hence, it is necessary to consider the social and economic contexts of families when attempting to improve indicators that go beyond mere healthcare intervention. In other words, infant health is the result of integrated public policies (eg. housing, employment/wages, education/training) and multi-level decisions and actions (local, municipal, regional, federal).