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Introduction Access to COVID-19-related care during the pandemic deserve attention and study to inform future strategies to deal with similar health emergencies in the future. We aimed to describe access to care for COVID-19-related reasons during the first 9 weeks of the pandemic in Portugal, to quantify the frequency of remote and in-person contacts with healthcare for COVID-19-related reasons and to assess the association between individual and context characteristics and contacts with health services.Methods We conducted an internet-based open cohort study with a non-probabilistic sample of 12 006 persons aged 16 years or more. One questionnaire was sent daily from 23 March 2020 for 9 weeks.Results General practitioners (GPs) were the main points of contact of patients with health services for COVID-19-related reasons. In our population, the main drivers found for any difference in the probability of contact with health services for COVID-19-related reasons were perceived high-risk contacts, followed by the existence of COVID-19 main symptoms. There were 17% more (0.17, 95% CI 0.15 to 0.18) contacts with health services among participants who reported personal contact with a confirmed case, 7% more (0.07, 95%CI 0.06 to 0.07) contacts if the contact had been with a suspected case and 6% more (0.06, 95%CI 0.05 to 0.07) contacts among participants who reported COVID-19 main symptoms in the previous 24 hours. Sociodemographic and household factors were not associated with major differences in healthcare contacts. The probability of contact with any health service for COVID-19-related reasons was highest at the beginning of the pandemic.Conclusion Most contacts with health services for COVID-19-related reasons during the first wave of the pandemic were with GPs, highlighting the role of first-contact care with these clinicians in Portuguese Primary Care, particularly in the context of the COVID-19 pandemic. Sociodemographic and household factors were not associated with major risk differences, suggesting that universal coverage and equity worked in our study sample at this pandemic stage.

ABSTRACT OBJECTIVE To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo. METHODS This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression. RESULTS The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern. CONCLUSION The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies.

The aim of the current work was to compare the (poly)phenol profile (free, soluble-conjugate, and insoluble-bound) and antioxidant activity of date palm seed flour using different extraction methods (conventional vs. ultrasound-assisted extraction [UAE]) and to determine the most critical variables in the extraction of (poly)phenols through UAE using the Plackett–Burman design experiment. Using the Plackett–Burman design, seven factors, namely, ethanol concentration, liquid:solid ratio (mL/g), sonotrode, amplitude (%), extraction time, extractant pH, and extraction cycle, were studied. After the factors were studied using conventional extraction methods, 23 compounds were quantified, with protocatechuic acid and catechin being the predominant (poly)phenols. Furthermore, the distribution of (poly)phenols within the cell varied, with glycosylated quercetins and caffeoyl shikimic acids predominantly found in free forms. Ultrasound-assisted extraction demonstrated efficiency in extracting free and soluble-conjugate (poly)phenols. However, it showed limitations in extracting insoluble-bound (poly)phenols. Nevertheless, similar amounts of total (poly)phenols were shown after conventional extraction and UAE, that is, 259.69 ± 43.54 and 189.00 ± 3.08 mg/100 g date seed flour, respectively. The Plackett–Burman design revealed the liquid–solid ratio as a crucial factor affecting (poly)phenol extraction, with higher ratios yielding better results. The sonotrode choice also influenced the extraction efficiency, highlighting that the sonotrode with a smaller diameter but higher displacement amplitude showed the best polyphenol recovery and antioxidant activity values. The nature of (poly)phenols influenced the studied extraction variables differently, emphasizing the complexity of the extraction process. In this line, pure water was sufficient to extract flavan-3-ols after UAE, whereas ethanol was a crucial factor in extracting quercetin. These findings underscore the importance of optimizing extraction methods for maximizing (poly)phenol recovery from date palm seed flour for various applications in food and pharmacology industries.

Fuchsia hybrida (pena pena) and Alcea rosea L. (malvagoma) are predominant flowers in the “Horchata” infusion, a traditional beverage in southern Ecuador, to which some medicinal properties are attributed. However, there is very little published information about these two flower species. The current study aimed to obtain two dehydrated powders of these flowers and to determine their chemical composition, physicochemical and technological properties, polyphenols, and fatty acids profile. In both powdered flowers, carbohydrates predominated, with a significant content of dietary fiber and fructose. The fat content was low, mainly comprising polyunsaturated fats (62% pena pena and 52% malvagoma), with a significant presence of omega-3 (C18:3n-3,6,9) and omega-6 (C18:2n-6,9) fatty acids, showing a better n-6/n-3 balance in the malvagoma flowers. Pena pena flowers are highlighted by high anthocyanin and ellagic acid amounts, whereas malvagoma contains a high content of flavanones. In conclusion, the studied powder flowers, could be used in the formulation of new foods or as source of anthocyanins as food colorants.

The trend in today’s society is to increase the intake of vegetable protein instead of animal protein. Therefore, there is a concern to find new sources of alternative protein. In this sense, legumes are the main protein source of vegetable origin. Of all of them, lupins are the ones with higher protein content, although they are currently undervalued as an alternative for human consumption. In this sense, it is vital to characterize and obtain protein isolates from this legume, which satisfies the growing demand. Therefore, in the present work, the procedure for obtaining a lupin (Lupinus luteus) protein isolate (LPI), based on basic solubilization followed by isoelectric precipitation, has been optimized and validated. The optimized LPI, as well as the lupin flour, were subsequently characterized. The chemical composition, physicochemical, as well as the technofunctional properties of the LPI were analyzed. The results show that the proposed procedure had a high yield (23.19 g LPI/100 g flour) and allowed to obtain high-purity protein isolates (87.7 g protein/100 g LPI). The amino acid composition and the chemical scores show high proportions of essential amino acids, being protein deficient only in methionine and valine. Therefore, it can be affirmed that it is a high-quality protein that meets the requirements proposed by the FAO. Regarding the lipid fraction, it is mainly composed of unsaturated fatty acids (C18:1n-9 and C18:2n-6), which is also advisable in order to follow a healthy diet. Finally, LPI showed interesting technofunctional properties (foaming, gelling, emulsifying, water and oil absorption, and solubility), which makes it especially attractive for use in the food industry.

It is now widely demonstrated that excessive salt consumption can cause various health problems, and meat products are among the foods most consumed with a high salt content. For that, the aim of this work was to assess the effects of the utilization of flours obtained from oyster mushrooms (Pleurotus ostreatus), button mushrooms (Agaricus bisporus), and portobello mushrooms (Agaricus brunnescen) as salt replacers on chemical, physicochemical, and sensory properties of beef burgers. The fat and protein content was not affected by the inclusion of mushroom flour, while the sodium content was reduced by 55–61% compared to the control sample. The control sample had the lowest values for cooking loss and shrinkage (12.29 and 18.69%, respectively) whilst the reformulated samples had higher values ranging between 16.08 and 18.88% for cooking loss, respectively, and between 19.55 and 28.25% for shrinkage, respectively. The reformulated samples showed higher lipid oxidation values (ranging from 0.18 and 0.20 mg malondialdehyde/kg sample) than the control sample. Sensorially, all parameters analyzed were not affected by the replacement of sodium chloride by the different mushroom flours. The use of flours obtained from different mushroom flours is a viable alternative to be used as sodium chloride replacers in the preparation of beef burgers.

OBJECTIVE: Birth cohorts collect valuable and under-utilized information on employment and health of parents before and during pregnancy, at birth, and sometimes after birth. In this discussion paper, we examine how these data could be exploited to study the complex relationships and interactions between parenthood, work, and health among parents themselves. METHODS: Using a web-based database of birth cohorts, we summarize information on maternal employment and health conditions and other potentially related variables in cohorts spread throughout Europe. This provided information on what data are available and could be used in future studies, and what was missing if specific questions are to be addressed, exploiting the opportunity to explore work–health associations across heterogenous geographical and social contexts. RESULTS: We highlight the many potentialities provided by birth cohorts and identify gaps that need to be addressed to adopt a life-course approach and investigate topics specific to the peri-pregnancy period, such as psychosocial aspects. We address the technical difficulties implied by data harmonization and the ethical challenges related to the repurposing of data, and provide scientific, ecological and economic arguments in favor of improving the value of data already available as a result of a serious investment in human and material resources. CONCLUSIONS: There is a hidden treasure in birth cohorts that deserves to be brought out to study the relationships between employment and health among working parents in a time when the boundaries between work and life are being stretched more than ever before.

The treatment for osteomyelitis consists of surgical debridement, filling of the dead space, soft tissue coverage, and intravenous administration of antimicrobial (AM) agents for long periods. Biomaterials for local delivery of AM agents, while providing controllable antibiotic release rates and simultaneously acting as a bone scaffold, may be a valuable alternative; thus, avoiding systemic AM side effects. V-HEPHAPC is a heparinized nanohydroxyapatite (nHA)/collagen biocomposite loaded with vancomycin that has been previously studied and tested in vitro. It enables a vancomycin-releasing profile with an intense initial burst, followed by a sustained release with concentrations above the Minimum Inhibitory Concentration (MIC) for MRSA. In vitro results have also shown that cellular viability is not compromised, suggesting that V-HEPHAPC granules may be a promising alternative device for the treatment of osteomyelitis. In the present study, V-HEPHAPC (HEPHAPC with vancomycin) granules were used as a vancomycin carrier to treat MRSA osteomyelitis. First, in vivo Good Laboratory Practice (GLP) toxicological tests were performed in a rabbit model, assuring that HEPHAPC and V-HEPHAPC have no relevant side effects. Second, V-HEPHAPC proved to be an efficient drug carrier and bone substitute to control MRSA infection and simultaneously reconstruct the bone cavity in a sheep model.

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.

Translation of research into public health policy is featured in common definitions of epidemiology, as an end result of scientific discovery on disease occurrence and causes. This dual nature of epidemiology, which brings together discovery and its use, seems to imply two main dimensions by which to judge epidemiologic research: technical or field-specific quality and societal value. This paper uses our research on the epidemiology of rheumatic and musculoskeletal disorders as a starting point to discuss the interface between these dimensions, exploring a number of conceptual, practical and ethical challenges that epidemiologists increasingly need to address when aiming for research translation. Those include not only the appraisal of the technical quality of research, which is familiar to researchers, but also the judgement on the usefulness and actual use of knowledge, as well as the assessment of the legitimacy of research based on translation potential. Several challenges lie ahead, but interdisciplinary conceptual and technical developments have the potential to guide future epidemiologic research of consequence. Approaches that recognize complexity and formalize the involvement of stakeholders in the research process within transparent frameworks open promising avenues for an effective translation of epidemiologic research projected into the future.

Digital proximity tracing (DPT) for Sars-CoV-2 pandemic mitigation is a complex intervention with the primary goal to notify app users about possible risk exposures to infected persons. DPT not only relies on the technical functioning of the proximity tracing application and its backend server, but also on seamless integration of health system processes such as laboratory testing, communication of results (and their validation), generation of notification codes, manual contact tracing, and management of app-notified users. Policymakers and DPT operators need to know whether their system works as expected in terms of speed or yield (performance) and whether DPT is making an effective contribution to pandemic mitigation (also in comparison to and beyond established mitigation measures, particularly manual contact tracing). Thereby, performance and effectiveness are not to be confused. Not only are there conceptual differences but also diverse data requirements. For example, comparative effectiveness measures may require information generated outside the DPT system, e.g., from manual contact tracing. This article describes differences between performance and effectiveness measures and attempts to develop a terminology and classification system for DPT evaluation. We discuss key aspects for critical assessments of whether the integration of additional data measurements into DPT apps may facilitate understanding of performance and effectiveness of planned and deployed DPT apps. Therefore, the terminology and a classification system may offer some guidance to DPT system operators regarding which measurements to prioritize. DPT developers and operators may also make conscious decisions to integrate measures for epidemic monitoring but should be aware that this introduces a secondary purpose to DPT. Ultimately, the integration of further information (e.g., regarding exact exposure time) into DPT involves a trade-off between data granularity and linkage on the one hand, and privacy on the other. More data may lead to better epidemiological information but may also increase the privacy risks associated with the system, and thus decrease public DPT acceptance. Decision-makers should be aware of the trade-off and take it into account when planning and developing DPT systems or intending to assess the added value of DPT relative to the existing contact tracing systems.

Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD).Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018.Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of

The cacao shell (CS) and cacao pod husk (CPH), two of the most promising high-fiber co-products of the cacao agro-industrial chain, were evaluated to determine their potential incorporation into food products. This research determined bioactive compounds and techno-functional properties of CS and CPH, and was evaluated the enzymatic inactivation by thermal treatments in CPH. We found that CS is rich in protein, lipids, dietary fiber (48.1 ± 0.3 g 100 gdw−1), and antioxidant molecules such as epicatechin (1.10 ± 0.02 mg g−1) and isoquercetin (1.04 ± 0.09 mg g−1). Moreover, in CS a positive effect of hydration mechanism occur; in fact, it was observed a reduction of Lightness (L∗) value and a remarkable color difference (ΔE∗,18.8 ± 0.7) (CIEL∗a∗b∗ color space), between hydrated and dry CS samples; so, it could be used as a potential natural colorant in foods. CPH resulted equally rich in dietary fiber (35.3–37.4%) and flavonoids (2.9 ± 0.1 mg RE g−1); in this co-product, the rapid enzymatic inactivation by thermal treatments was essential to obtain the highest antioxidant activity and polyphenols content; regarding the techno-functional properties, it was found that CPH flour had high hydration capacity, so CPH can use it as a replacement for emulsifiers or water holding additives while incorporating the fiber and abundantly found antioxidants.

Introduction: The large number of passengers, limited space and shared surfaces can transform public transportation into a hub of epidemic spread. This study was conducted to investigate whether proximity to railway stations, a proxy for utilization, was associated with higher rates of SARS-CoV-2 infection across small-areas of the Lisbon Metropolitan Area (Portugal).Methods: The number of SARS-CoV-2 confirmed infections from March 2 until July 5, 2020 at the parish-level was obtained from the National Epidemiological Surveillance System. A Geographic Information System was used to estimate proximity to railway stations of the six railway lines operating in the area. A quasi-Poisson generalized linear regression model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (95%CI).Results: Between May 2 and July 5, 2020, there were a total of 17,168 SARS-CoV-2 infections in the Lisbon Metropolitan Area, with wide disparities between parishes. Overall, parishes near any of the railway stations of the Sintra line presented significantly higher SARS-CoV-2 infection rates (RR = 1.42, 95%CI 1.16, 1.75) compared to parishes located farther away from railway stations, while the opposite was observed for parishes near other railway stations (Sado and Fertagus lines), where infection rates were significantly lower than those observed in parishes located farther away from railway stations (RR = 0.66, 95%CI 0.50, 0.87). The associations varied according to the stage of the epidemic and to the mitigation measures enforced. Regression results also revealed an increasing influence of socioeconomic deprivation on SARS-CoV-2 infections.Conclusions: No consistent association between proximity to railway stations and SARS-CoV-2 infection rates in the most affected metropolitan area of Portugal was observed, suggesting that other factors (e.g., socioeconomic deprivation) may play a more prominent role in the epidemic dynamics.

The aim of this work was to evaluate the effect of partially replacing fat by the addition of three quinoa pastes obtained from white, red and black quinoa on the quality and safety of a cooked meat product such as pork liver pâté. The addition of quinoa paste as fat replacer led to an increase in the moisture, ash and residual nitrite contents, while the fat content decreased with respect to control sample by an average of 8%. The use of quinoa pastes increased the hardness and the gumminess but had no effect on springiness and cohesiveness. The substitution of fat with white, red and black quinoa paste at 10% led to lower oxidation rates than observed in the control. No aerobic bacteria, Enterobacteriaceae, moulds and yeasts were found in any sample. The most acceptable sample was the pâté containing red quinoa at 5%.

The aim of this work was to evaluate the effects on the chemical, physic-chemical, technological, and sensory properties of beef burger when replacing different quantities of fat (50 and 100%) with different levels of oil-in-water-gelled emulsion elaborated with walnut oil and cocoa bean shell flour (GECW). The chemical composition of the samples was affected by the fat replacement. The reformulation increased the moisture and ash content while the fat and protein content decreased with respect to the control sample. The linolenic and linolenic acid content of the beef burgers increased as the GECW replacement was augmented. The polyunsaturated fatty/saturated fatty acid ratio increased in both raw and cooked burgers, whereas the atherogenicity index and thrombogenicity index were reduced in both raw and cooked burgers with respect to the control sample. The use of GECW as a fat replacer was found to be effective in improving the cooking loss. Similarly, there were positive effects on reductions in the diameter and the increases in the thickness of the beef burgers. Regarding lipid stability, in both the raw and cooked burgers, the reformulation increased the 2-thiobarbituric acid reactive substance (TBARs) values with respect to the control sample. In both types of reformulated burgers, three bound polyphenols (mainly catechin and epicatechin) and two free polyphenols were identified, as were methylxanthines theobromine and caffeine. The sensory properties for the control and partial pork backfat replacement treatments were similar, while the sample with the total pork backfat replacement treatment showed the lowest scores. The blend of cocoa bean shell flour and walnut oil could be used as new ingredients for the development of beef burgers with a healthier nutritional profile without demeriting their sensory or cooking characteristics and physic-chemical properties.

The aim of this work was to evaluate the effect of simulated in vitro gastrointestinal digestion (GID) on (i) phenol and flavonoid recovery and bioaccessibility indexes, (ii) the antioxidant activity and (iii) the polyphenolic profile of six quinoa seeds. The recovery indexes obtained after the oral, gastric and intestinal digested fractions of quinoa seeds showed increasing concentrations of both total phenolic and flavonoid content. After GID, the average bioaccessibility percentage of samples was 73.29 and 12.64 for phenols and flavonoids, respectively. The LC-MS results obtained showed that the concentration of the polyphenolic compounds analyzed decreased after GID, although DPPH, TEAC-ABTS, FRAP and FIC assays pointed to a large increase in antioxidant activity. Of the investigated samples, red and black quinoa seeds showed the highest antioxidant activity, although they also seemed to be the most affected by GID. Further studies should be undertaken to understand the bioaccessibility of bioactive compounds in quinoa seeds and the factors that interfere with the same.

Abstract Qualitative similarities between hip fracture trends in different countries suggests variations of the same epidemic. We tested a single statistical shape to describe time trends in Europe, while allowing for country-level variability. Using data from 14 countries, we modelled incidence rates over time using linear mixed-effects models, including the fixed effects of calendar year and age. Random effects were tested to quantify country-level variability in background rates, timing of trend reversal and tempo of reversal. Mixture models were applied to identify clusters of countries defined by common behavioural features. A quadratic function of time, with random effects for background rates and timing of trend reversal, adjusted well to the observed data. Predicted trend reversal occurred on average in 1999 in women (peak incidence about 600 per 100 000) and 2000 in men (about 300 per 100 000). Mixture modelling of country-level effects suggested three clusters for women and two for men. In both sexes, Scandinavia showed higher rates but earlier trend reversals, whereas later trend reversals but lower peak incidences were found in Southern Europe and most of Central Europe. Our finding of a similar overall reversal pattern suggests that different countries show variations of a shared hip fracture epidemic.

PurposeWe aimed to describe bone formation and resorption markers in generally healthy prepubertal children using total alkaline phosphatase (tALP), osteocalcin (OC) and β-isomerized C-terminal telopeptides of type I collagen (β-CTx) serum concentrations and to estimate markers' correlations with anthropometric growth (height, weight, body mass index and trajectories of weight gain) as well as bone mineral content (BMC) and areal density (aBMD).MethodsWe assessed 395 7-year-old children from the Generation XXI cohort with tALP, OC and β-CTx concentrations determined from a fasting venous blood sample and BMC/aBMD measured by dual-energy X-ray absorptiometry. Gender-specific reference intervals for tALP, OC and β-CTx in 7-year-old children were established by calculating the 2.5th and 97.5th percentiles. Pearson and partial correlation coefficients (controlling for sex, age, body size and season) between bone markers and growth measures were computed.ResultstALP increased with height (rpartial controlled for sex = 0.26, 95%CI: 0.17, 0.35), was higher in overweight than in healthy weight children, and in children who gained weight above average during infancy. No correlations were found between OC or β-CTx and growth. In girls, OC was slightly correlated with subtotal BMC (rpartial = 0.22, 95%CI: 0.08, 0.35), subtotal aBMD (rpartial = 0.20, 95%CI: 0.06, 0.33) and lumbar spine aBMD (rpartial = 0.23, 95%CI: 0.09, 0.36). tALP and β-CTx were not correlated with any of the DXA-derived bone measures.ConclusionThis study contributed to the description of bone turnover at 7 years of age and suggested that bone metabolism markers measured in a single point in time have limited ability to describe anthropometric growth and overall bone status in generally healthy prepubertal children.

The cocoa pod husk is considered a source of dietary fiber with a high content of water-soluble pectins, bioactive compounds which should be viewed as a by-product with the potential to be incorporated into food. This study aimed to investigate the effect of adding different cocoa pod husk flour (CPHF) levels as a starch replacement for reformulating frankfurters. Results showed that the addition of 1.5 and 3.0% pod husk proportionally increased the frankfurter’s fiber content by 0.49 ± 0.08 and 0.96 ± 0.19 g/100 g, which is acceptable for a product that does not contain fiber. Textural properties and sensory characteristics were affected when substituting the starch with CPHF, either totally or partially, although these samples had higher water content, hardness, and adhesiveness while springiness decreased. Non-adverse effects of nitrite on polyphenolic compounds content were evidenced in samples enriched with CPHF. The incorporation of CPHF did not significantly affect the color parameters (ΔE < 3). Finally, the panelists indicated a sensation of the unsalted sausage, suggesting that CPHF may have natural mucoadhesion properties. In conclusion, in formulated meat products such as sausages, plant co-products such as cacao pod husks could be a valid new ingredient to improve technological parameters, functional characteristics, and stability.

Agrofood coproducts are used to enrich meat products to reduce harmful compounds and contribute to fiber and polyphenol enrichment. Pork liver pâtés with added persimmon coproducts (3 and 6%; PR-3 and PR-6, respectively) were developed. Therefore, the aim was to study the effect of their in vitro gastrointestinal digestion on: the free and bound polyphenol profile (HPLC) and their colon-available index; the lipid oxidation (TBARs); and the stability of the fatty acid profile (GC). Furthermore, the effect of lipolysis was investigated using two pancreatins with different lipase activity. Forty-two polyphenols were detected in persimmon flour, which were revealed as a good source of bound polyphenols in pâtés, especially gallic acid (164.3 µg/g d.w. in PR-3 and 631.8 µg/g d.w. in PR-6). After gastrointestinal digestion, the colon-available index in enriched pâté ranged from 88.73 to 195.78%. The different lipase activity in the intestinal phase caused significant differences in bound polyphenols’ stability, contributing to increased lipid oxidation. The fatty acids profile in pâté samples was stable, and surprisingly their PUFA content was raised. In conclusion, rich fatty foods, such as pâté, are excellent vehicles to preserve bound polyphenols, which can reach the colon intact and be metabolized by the intestinal microbiome.

The worldwide cocoa bean shell (CBS) generation is estimated at around 900,000 tons. In their composition, this coproduct showed several bioactive compounds like methylxanthines or polyphenolic compounds. Thus, the aim of this work was to investigate the effects of different particle sizes on the chemical composition, physico-chemical, bioactive compounds content, and antioxidant properties of flours obtained from cocoa (Theobroma cacao L.) bean shells. The flours obtained from CBS with different particle sizes had high content of dietary fiber (61.18–65.58 g/100 g). The polyphenolic profile identified seven compounds being epicatechin and catechin (values ranged 4.56–6.33 and 2.11–4.56 mg/g, respectively) as the most abundant compounds. Additionally, the methylxanthines theobromine and caffeine were quantified with values ranging from 7.12 to 12.77 and 4.02 to 6.13 mg/g, respectively. For the fatty acid profile, the principal compounds identified were oleic, stearic and palmitic acids. CBS had antioxidant capacity with all methods assayed. For DPPH, ABTS and FRAP assays values ranged between 2.35–5.53, 3.39–11.55, and 3.84–7.62 mg Trolox equivalents/g sample, respectively. This study suggests that cocoa bean shells may constitute a valuable coproduct for the food industry due to its high content in valuable bioactive compounds.

Chia and quinoa have gained popularity among consumers worldwide due to the wide variety of nutrients but also to the bioactive compounds that they contain. Lately, their processing has generated different coproducts (non-commercial grains, flour, partially deoiled flour, rich-fiber fraction, and oil, among others), which could be reincorporated to the food chain with important technological properties, antioxidant activity included. Both sets of ingredients have been revealed a great technological potential for meat product development and innovation, taking into account that oxidation is one of the main reactions responsible for their deterioration and shelf life reduction. This review focuses on the antioxidant compounds of chia and quinoa coproducts and on the strategies used to add them to meat products highlighting their effect on the lipid oxidation control. Apart from the different ways in which quinoa and chia can be incorporated into meat products and their antioxidant properties, innovative approaches for increasing this antioxidant effect and counteracting any negative alterations they may cause will be discussed.

The goals of this research were determined the proximate composition, physico-chemical, techno-functional properties, the polyphenolic profile, the organic acids and sugar content and the antioxidant capacities of flours obtained from almonds skins var. comuna (ASFC) and var. fritz (ASFF) coproducts produced in Turrón industry. The chemical composition and physico-chemical properties (pH, water activity and color) were determined. The water holding, oil holding and swelling capacities were also determined, as well as the polyphenolic profile. For the antioxidant capacity, four different assays were used namely: 2,2-diphenyl-1-picrylhydrazyl radical scavenging assay (DPPH•); Ferrous ions chelating activity (FIC); Ferric reducing antioxidant power (FRAP) and 2,2′-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) radical scavenging assay (ABTS•+). The flours obtained from ASFC and ASFF had a high content of dietary fiber (70.50 and 69.83 g/100 g, respectively). The polyphenolic profile, determined by High Performance Liquid Chromatography, identified 21 and 19 polyphenolic compounds in both ASFC and ASFF, being epicatechin and catechin the most abundant compounds. In reference to the antioxidant capacity regards, with all methods assayed except FRAP, ASFC had higher antioxidant activity than ASFF. These coproducts show good technological and antioxidant properties, which makes them a good alternative for its use in the development of new foods.

The incorporation of a new ingredient into foods could not only affect the intrinsic properties of the product but also its shelf life. The aim of this study was to investigate the effect of the black quinoa (both as whole seeds and as the fibre-rich fraction obtained as coproduct from its wet-milling process) on the shelf life of Bologna-type sausages during cold storage. Three treatments of Bologna-type sausages were produced: control, sausages with black quinoa seeds (2.5%), and sausages with their fibre-rich fraction (2.5%). The effect of the black quinoa added on the physicochemical properties (pH and colour), lipid oxidation, residual nitrite level, and microbiological quality of Bolognas during 21 days of cold storage was evaluated. Although the addition of quinoa products in Bologna-type sausages modified some colour parameters (day 0), these differences were masked through the storage period. Sausages with quinoa products added showing lipid oxidation values lower than the control for all the days studied. Sausages with quinoa products added showed higher residual nitrite levels than control at all measurement times during the storage period. The addition of black quinoa did not affect microbial stability during storage. Black quinoa products can be considered promising ingredients to be used as antioxidants and natural nitrate sources in Bologna-type sausages without affecting their microbial safety during storage.

OBJECTIVES: This study aimed to describe patterns of occupational biomechanical demands in the beginning of professional life and to quantify their association with the presence and intensity of regional musculoskeletal pain. METHODS: Cross-sectional data from 21-year-old participants were collected during the third wave of the EPITeen cohort study (N=1733, 37.5% were workers). Ten different work-related biomechanical tasks were characterized. Latent class analysis was conducted to identify empirical patterns of occupational biomechanical demands. The presence and intensity of regional musculoskeletal pain in the previous year were also evaluated. RESULTS: Four patterns of occupational biomechanical demands were found: “low demands”, “sitting demands”, “repetitive and asymmetric demands”, and “high and vibrational demands”. When compared to workers with low demands, those with repetitive and asymmetric demands or high and vibrational demands presented 80% higher adjusted odds ratio (OR_adj) of reporting neck/shoulder pain. High and vibrational demands occupations were significantly associated with upper-/lower-back pain in comparison to low demands [OR_adj 1.80, 95% confidence interval (95% CI%) 1.09–2.96]. In addition, workers with sitting demands were more likely to report any or severe upper-/lower-back pain [OR_adj 1.56 (95% CI 0.99–2.45) and 1.66 (95% CI 1.03–2.66), respectively] when compared to those with low demands. CONCLUSIONS: Patterns of high work-related physical demands were associated with the presence of neck/shoulder pain and severity of upper-/lower-back pain. This emphasizes that even short-term biomechanical exposures at the workplace may be involved in the etiology of musculoskeletal complaints.

Objetivo: Estabelecer as recomendações portuguesas relativas à indicação de realização da DXA e de iniciação de tratamento para a prevenção de fraturas de fragilidade. Métodos: Foi reunido um painel multidisciplinar, representando o leque das especialidades médicas e associações de doentes dedicadas à osteoporose, bem como especialistas nacionais neste domínio e em economia da saúde, com o objetivo de desenvolver recomendações com base na evidência científica e no consenso dos especialistas. As decisões foram suportadas por dados epidemiológicos, sócio-económicos e de qualidade de vida obtidos recentemente sobre as fraturas osteoporóticas. Resultados: Foram desenvolvidas 10 recomendações que abordam as questões de quem deve ser objeto de investigação com a DXA e quem deve ser tratado com terapêutica para prevenção de fraturas. Os limiares para a avaliação e intervenção baseiam-se na análise de custo-eficácia das intervenções em diferentes limiares da probabilidade a dez anos de fratura osteoporótica, calculados com base na versão portuguesa da FRAX® (FRAX®Port) tendo em consideração os dados epidemiológicos e económicos portugueses. Enumeram-se as limitações da FRAX® e, sempre que possível, propõem-se orientações para uma adaptação. Conclusões: Os limiares de custo-eficácia para realização de DXA e a instituição de terapêutica para a prevenção das fraturas de fragilidade são agora facultados à população portuguesa. Estes limiares são práticos, baseiam-se em dados epidemiológicos e económicos nacionais e em evidência científica e são corroborados por um painel multidisciplinar de especialistas e de instituições científicas. A implementação destas recomendações oferece perspetivas muito promissoras no que diz respeito a uma utilização mais eficaz dos recursos de saúde na prevenção das fraturas osteoporóticas em Portugal.

Los derechos de las personas transexuales en el Estado español son el resultado de complejas negociaciones que tienen lugar en nuestra historia reciente, que alude a las libertades democráticas, los derechos sexuales y reproductivos, así como de cierta conformación identitaria de los movimientos sociales que sucede desde la transición democrática. En un tiempo record, aquellos considerados como vagos y maleantes, peligrosos sociales, pasaron a ser travestis, transexuales y más tarde activistas y sujetos de derecho. En este devenir de un sujeto político inteligible, queremos fijarnos en la encrucijada de los movimientos feministas y trans*, que facilitan una perspectiva crítica sobre el papel del Estado y de la legislación, así como de la medicina a la hora de garantizar derechos a las personas trans*. Para ello hemos entrevistado a activistas clave, revisado la literatura de los movimientos sociales y presentado algunas hipótesis arriesgadas que ponemos a prueba con sus protagonistas.

Neste estudo procede-se à avaliação sócioeconómica do ecossistema montado no Alentejo, em termos da viabilidade dos actuais sistemas de produção e dos efeitos da política agrícola na sua competitividade e sustentabilidade. A metodologia utilizada baseou-se na construção de matrizes de análise política. Em função dos níveis de rendimento e dos efeitos das medidas de política agrícola, os sistemas de produção são classificados em termos da sua contribuição real para o crescimento económico.This paper makes a socio-economic evaluation of the "Montado" ecosystem in Alentejo. It is study the viability of the agricultural systems and the effects of agricultural policy in their competitiveness and sustainability. It is used a Policy Analysis Matrix to evaluate the agricultural systems competitiveness and their economic efficiency. The agricultural systems are classified concerning their contribution for the economic growth, in function of income levels and policy effects.

Patterns in the use of medicines are expected to reflect distinct health features between populations. This study aimed to describe the self-reported use of medication by a sample of university students in Maputo, Mozambique. We conducted a survey of 797 students in a private university in Maputo. Participants completed a questionnaire including socio-demographic data and pattern of medication use in the preceding month. Information was collected on the number and names of drugs, duration of use, and prescription. The drugs were grouped according to therapeutic indication. In the previous month, 56% of students had used at least one pharmaceutical drug, with higher prevalence for women (65.2% vs. 42.2%) and men attending health-related courses (67.4% vs. 53.2%). The most commonly used medicines were anti-inflammatory/analgesic drugs (62.2%), anti-infectives (25.9%), and vitamins/minerals (13.6%). The most frequently used single drugs were paracetamol (42.8%), amoxicillin (12.6%), and ibuprofen (8.4%). Duration of use was lowest for anti-inflammatory/analgesic drugs and highest for oral contraceptives. Use of medication by Mozambican students was similar to that observed in other university populations.O padrão de utilização de medicamentos nas populações pode refletir diferenças na sua saúde. O objetivo deste estudo foi descrever o uso de medicamentos numa população universitária em Maputo, Moçambique. Foram avaliados 797 estudantes de uma universidade privada. Os participantes preencheram um questionário que incluía variáveis sócio-demográficas e de utilização de medicamentos no mês anterior. Foi colhida informação relativa ao número e nome dos medicamentos, duração da utilização e prescrição. Os fármacos foram classificados conforme a indicação terapêutica. Entre os estudantes, 56% tinham utilizado pelo menos um fármaco, com maior prevalência nas mulheres (65,2% vs. 42,2%) e nos homens que freqüentavam cursos de saúde (67,4% vs. 53,2%). Os estudantes usaram principalmente antiinflamatórios/analgésicos (62,2%), anti-infecciosos (25,9%) e vitaminas/minerais (13,6%). Os fármacos mais freqüentemente utilizados foram paracetamol (42,8%), amoxicilina (12,6%) e ibuprofeno (8,4%). A duração da terapêutica foi menor para antiinflamatórios/analgésicos e maior para contraceptivos orais. O padrão de utilização de medicamentos por estudantes moçambicanos foi semelhante ao observado noutras populações universitárias.

The current labour market is becoming more flexible and informal, with job insecurity selectively affecting young workers. However, the role of these increasing adverse psychosocial working conditions on health outcomes remains little known among newly employed workers.To estimate the associations between psychosocial work environment and musculoskeletal outcomes (widespread pain syndrome features and regional pain) in a population-based sample of young workers.Cross-sectional data from workers aged 21 years were collected during the third wave of the EPITeen cohort study (2011-2013; n=650). The Job Content Questionnaire was used to characterize the psychosocial work environment according to the demand-control-support model. Data on pain and non-pain dimensions of the widespread pain syndrome (Fibromyalgia Survey Questionnaire) as well as on regional musculoskeletal pain (Nordic Musculoskeletal Questionnaire) were also collected. Crude and adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were computed using logistic regression and all estimates were adjusted for sex, education and occupational biomechanical demands.Job insecurity was significantly associated to the non-pain dimension of the widespread pain syndrome (adjusted OR [95% CI]=1.51 [1.08, 2.12]). Young workers with strain jobs were significantly more likely to report high levels of non-pain symptoms when compared with those with no-strain jobs and this effect was even stronger when social support was added to the main exposure: workers with strain jobs and low social support had twice the odds of reporting high levels of non-pain features than those with high strain but high social support jobs (adjusted OR=1.86, 95% CI: 1.04, 3.31). These significant associations were not observed when widespread pain or multisite regional pain were the outcomes.In the beginning of professional life, high strain jobs were associated to non-pain complaints, especially when the work environment provided also low social support.

BACKGROUND: Adolescence is a critical stage for bone accrual. It is also decisive for the establishment of behaviors such as smoking and alcohol drinking. OBJECTIVE: To quantify the short- and long-term associations between smoking and drinking initiation and bone mineral density in adolescent girls. METHODS: We used prospective data from 731 girls identified in public and private schools in Porto, Portugal. Evaluations were conducted when participants were 13 and 17 years old. Bone mineral density (BMD) was measured at the forearm by dual-energy X-ray absorptiometry and weight, height and fat-free mass were measured. Pubertal development status was estimated using menarche age. Self-administered questionnaires were used to collect data on smoking and alcohol drinking, physical exercise and calcium and vitamin D intakes. BMD in early and late adolescence was analyzed as a continuous or dichotomous (Z-score cutoff: -1.0) variable. Associations were calculated using linear or logistic regression. RESULTS: Over one quarter of these girls had tried smoking by 13, while 59% had drunk alcoholic beverages and 20% had experienced both behaviors by that age. Lower mean BMD at 17 years of age was observed in girls who had ever smoked by 13, as well as in those who reported drinking at that age. There were no significant cross-sectional associations between experience and frequency of smoking or drinking and BMD at 13 years of age. However, we observed significant associations between BMD z-score

BACKGROUND: Fracture healing is orchestrated by a specific set of events that culminates in the repair of bone and reachievement of its biomechanical properties. The aim of our work was to study the sequence of gene expression events involved in inflammation and bone remodeling occurring in the early phases of callus formation in osteoporotic patients. METHODOLOGY/PRINCIPAL FINDINGS: Fifty-six patients submitted to hip replacement surgery after a low-energy hip fracture were enrolled in this study. The patients were grouped according to the time interval between fracture and surgery: bone collected within 3 days after fracture (n = 13); between the 4(th) and 7(th) day (n = 33); and after one week from the fracture (n = 10). Inflammation- and bone metabolism-related genes were assessed at the fracture site. The expression of pro-inflammatory cytokines was increased in the first days after fracture. The genes responsible for bone formation and resorption were upregulated one week after fracture. The increase in RANKL expression occurred just before that, between the 4(th)-7(th) days after fracture. Sclerostin expression diminished during the first days after fracture. CONCLUSIONS: The expression of inflammation-related genes, especially IL-6, is highest at the very first days after fracture but from day 4 onwards there is a shift towards bone remodeling genes, suggesting that the inflammatory phase triggers bone healing. We propose that an initial inflammatory stimulus and a decrease in sclerostin-related effects are the key components in fracture healing. In osteoporotic patients, cellular machinery seems to adequately react to the inflammatory stimulus, therefore local promotion of these events might constitute a promising medical intervention to accelerate fracture healing.