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BACKGROUND: Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE: To assess the benefits of adding inspiratory muscle training to neuromuscular patients’ treatment and their compliance to the approach. METHODS: We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based on patients’ baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS: There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n= 12, 57.3%) and amyotrophic lateral sclerosis (n= 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p= 0.002) and peak cough flow (p= 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS: This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term.

Objectives Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. Methods The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. Results This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. Conclusions There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.

BACKGROUND: Cigarette smoking has a considerable health and economic burden in modern society, with increased risk of morbidity and mortality. Therefore, smoking cessation policies and medical treatments are essential. However, cessation rates are low and the abandonment of the consultation is common. The identification of characteristics that may predict adherence will help defining the best treatment strategy. This study aimed to identify predictors of follow-up loss in smoking cessation consultation. METHODS: We made a retrospective observational study, including a cohort of patients who started smoking cessation consultation (April-December 2018). Clinical data from consultations was collected and analyzed with IBM SPSS Statistics (SPSS, RRID:SCR_002865). RESULTS: A total of 175 patients was selected (41.1% female), with a mean age of 53±12 years. Eighty-five patients (48.6%) were discharged for abandonment. They had a median pack-year unit 38±36 (P=0.011), Fagerström and Richmond scores of 5±2 and 7±2, respectively. There was an association between women (P

Cardiovascular diseases represent the frst cause of death globally. Infammatory rheumatic disease (IRMD) patients, due to their lifelong infammatory status, are at increased risk of developing premature cardiovascular disease. We aimed to assess the risk for cardiovascular events (CVE) in a population-based study. We followed 10,153 adults from the EpiDoC Cohort, a large Portuguese population-based prospective study (2011–2016). IRMD patients were identifed at baseline and followed during 5 years. CVE were defned as a composite of self-reported myocardial infarction or angina pectoris, arrhythmias, valvular disease, stroke or transient ischemic attack and peripheral artery disease. Statistical analysis was performed by utilizing multivariate logistic regression and goodness-of-ft and area under ROC curve. At baseline, IRMD patients had similar age as the non-IRMD participants (mean age 55 vs 53 years-old; 72.1% female); dyslipidaemia and sedentary lifestyle were more common (40.7% vs 31.4%, p=0.033; 87.3% vs 67%, p=0.016, respectively). During an average follow-up of 2.6 years, 26 CVE were reported among IRMD patients. IRMD patients had higher odd of CVE (OR 1.64, 95% CI 1.04–2.58; p=0.03), despite comparable mortality rates (1.7% vs 0.7%, p=0.806). A stepwise approach attained that gender, age, history of hypertension, body mass index, IRMD and follow-up time are the most important predictive variables of CVE (AUC 0.80). IRMD patients, at community level, have an increased short-term risk of major CVE when compared to non-IRMD, and that highlights the potential beneft of a systematic screening and more aggressive cardiovascular risk assessment and management of these patients. info:eu-repo/semantics/publishedVersion

Aim: Quality of life (QoL) is one of the most important patient-reported outcomes in chronic diseases. Using a population-based cohort, our objective was to assess health-related QoL in individuals with a previous myocardial infarction (MI). Methods: This study was conducted on a large database representative of the adult Portuguese population aged 18 years or over, living in the community. Participants were assessed through telephone interview. A standardized questionnaire was applied to every individual about self-reported chronic diseases, including previous MI. QoL was assessed with the EQ-5D-3L version of EuroQol. The prevalence of previous MI was calculated and linear regression analysis was performed. Results: The estimated prevalence of previous MI in the adult Portuguese population was 1.1%. These patients were older and more often male, had lower income and lower education levels, and were more often from urban areas. Respondents with self-reported MI assigned a lower self-perception to their health status in all domains, particularly in mobility and anxiety/depression. The mean EQ-5D-3L score in patients with MI was 0.73±0.34, significantly lower than in patients without MI (0.78±0.29). Also, the number of chronic diseases was significantly higher in patients with MI (5.0±2.2 vs. 1.7±1.8). Previous MI was not independently associated with QoL, which was related to age, gender and number of comorbidities. Conclusions: Adults with previous MI have a worse self-perceived health status and QoL. Previous MI was not an independent predictor of health-related QoL after controlling for age, gender and associated chronic diseases. Resumo: Introdução: A qualidade de vida (QOL) é um dos mais importantes resultados reportados por doentes em doenças crónicas. Utilizando uma coorte baseada na população, foi nosso objetivo avaliar a qualidade de vida relacionada com a saúde em doentes com enfarte do miocárdio (EM) prévio. Métodos: Estudo realizado numa grande base de dados representativa da população portuguesa adulta com ≥ 18 anos, a viver na comunidade. Os participantes foram avaliados por entrevista telefónica e foi aplicado um questionário estandardizado a cada indivíduo sobre doenças crónicas autotreportadas, incluindo EM no passado. A QOL foi avaliada com a ferramenta EuroQol (EQ-5D-3L). Resultados: A prevalência estimada de EM prévio foi de 1,1%. Estes doentes são mais idosos e mais homens, com menor rendimento e nível de educação e mais frequentemente de áreas urbanas. Os indivíduos com EM prévio têm pior perceção do seu estado de saúde em todos os domínios, em particular na mobilidade e ansiedade/depressão. O índice EQ-5D-3L médio foi 0,73±0,34, significativamente inferior quando comparado com doentes sem EM (0,78±0,29). O número de doenças crónicas é significativamente superior em doentes com EM (5,6±2,2 versus 1,7±1,8). O EM prévio não se associa de forma independente à QOL, estando esta relacionada com idade, género e número de comorbilidades associadas. Conclusões: Adultos com EM prévio apresentam uma pior percepção da sua saúde e QOL. O EM prévio não é preditor independente de QOL após controlo para idade, género e doenças crónicas associadas.

Funding Information: This research was funded by the Portuguese Science and Technology Foundation (FCT) with the grant number CEECIND/04266/2017. Acknowledgments: The authors would like to thank Eunice Silva for technical support. Funding Information: Funding: This research was funded by the Portuguese Science and Technology Foundation (FCT) with the grant number CEECIND/04266/2017. Daytime hypersomnolence, the prime feature of obstructive sleep apnea (OSA), frequently leads to high coffee consumption. Nevertheless, some clinicians ask for patients’ caffeine avoidance. Caffeinated drinks are sometimes associated with more severe OSA. However, these effects are not consensual. Here we investigated the effect of caffeine consumption on sleep architecture and apnea/hypopnea index in OSA. Also, the impact of caffeine on variables related with dysmetabolism, dyslipidemia, and sympathetic nervous system (SNS) dysfunction were investigated. A total of 65 patients diagnosed with OSA and 32 without OSA were included after given written informed consent. Polysomnographic studies were performed. Blood was collected to quantify caffeine and its metabolites in plasma and biochemical parameters. 24 h urine samples were collected for catecholamines measurement. Statistical analyses were performed by SPSS: (1) non-parametric Mann-Whitney test to compare variables between controls and OSA; (2) multivariate logistic regression testing the effect of caffeine on sets of variables in the 2 groups; and (3) Spearmans’ correlation between caffeine levels and comorbidities in patients with OSA. As expected OSA development is associated with dyslipidemia, dysmetabolism, SNS dysfunction, and sleep fragmentation. There was also a significant increase in plasma caffeine levels in the OSA group. However, the higher consumption of caffeine by OSA patients do not alter any of these associations. These results showed that there is no apparent rationale for caffeine avoidance in chronic consumers with OSA. publishersversion published

Background The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients’ length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. Methods Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals’ financial situation (current ratio) was included. Results For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital’s current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. Conclusion Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.

Tympanostomy with ventilation tube insertion is the most common otologic surgery. Many surgeons recommend water precautions, although its utility is questioned. We aimed to investigate if water precautions reduce the rate of otorrhea after transtympanic tube insertion.Multicenter randomized controlled trial.A total of 244 children aged 2 to 10 years undergoing their first set of Shepard tubes for otitis media with effusion and concomitant adenoidectomy were randomized to 2 groups: 1 with ear protection during water exposure (ear plugs and headbands, n = 130) and 1 without (n = 114). Bathing or swimming with unprotected ears was considered the exposure event and incidence of otorrhea, the primary outcome. Outcomes were assessed during the 6-month follow-up period.In the water precaution group, 32% had at least 1 episode of otorrhea as compared with 22% in the unprotected group, which was not statistically significant (The incidence of otorrhea was not different with or without prescription of ear protection during water exposure among children with tympanostomy tubes, which supports current guideline recommendations that routine water precautions are unnecessary in this population.

Aims: Clinical risk factors and bone mineral densitometry underestimate low-energy fracture (LEF) risk in people with diabetes. We aim to estimate the prevalence of LEF in diabetics, compare with nondiabetics; and evaluate possible predictors of LEF in people with diabetes. Methods: Cross-sectional, population-based study in Portuguese subjects over 40 years-old. Estimates computed as weighted proportions/means, considering sample design. Multivariate logistic regression models to evaluate the association of diabetes and LEF; and predictors of LEF in diabetics. Results: 7675 subjects were analysed, of which 1173 reported diabetes. Diabetics were older (mean age 66.0 ± 11.49y), more frequently reported osteoporosis and falls in the previous 12 months (32.4% vs. 22.9%). Prevalence of self-reported LEF was 16.2% (95% CI:13.68-19.13) among diabetics (vs. 13.3%, 95% CI:12.14-14.57, in nondiabetics); OR for the association diabetes and LEF:1.26, 95% CI:1.01-1.58, p = 0.045 (in women, adjusted OR:1.41, 95% CI:1.05-1.89, p = 0.02). Thirty percent of diabetics reported at least one major LEF and 70% in other sites. In diabetics, LEF was independently associated with self-reported osteoporosis and falls in the previous 12 months. Conclusion: People with diabetes reported more falls and had higher prevalence of self-reported LEF. Self-reported osteoporosis and falls were associated with LEF in diabetics. Our findings emphasize the need for fracture and falls preventive measures in diabetics. info:eu-repo/semantics/publishedVersion

Aims: Chronic heart failure (HF) is a major comorbidity accounting for an increased severity and mortality related to coronavirus disease 2019 (COVID-19). To reduce the risk of COVID-19 in HF patients, telemedicine has been encouraged. Methods and results: During the COVID-19 pandemic, telemedical management with mainly over-the-phone appointments became a major strategy of follow-up of our HF clinic patients. Previously, the large majority of patients have been seen in the hospital with direct patient-provider contact. We compared both strategies of follow-up, in pre-pandemic (PPP) and pandemic (PP) periods, regarding total mortality and hospitalizations/emergency department (ED) visits due to HF exacerbation. We prospectively studied a cohort of 196 patients. The mean follow-up time in PPP was 1.4 years. In this period, 20 patients died. In PP (follow-up of 71 days), there was one additional death. Total mortality in the first year of follow-up was 12.0%, matching the mortality predicted by the Meta-Analysis Global Group in Chronic Heart Failure score. Considering hospitalizations/ED visits due to decompensated HF, there was no statistically significant difference between PPP and PP. Only one patient was diagnosed with COVID-19. Conclusions: In the light of an increase in telemedical management of this cohort of HF patients, we were able to maintain a low rate of admissions due to HF decompensation, without an increment in mortality. Regarding these results, we encourage the incremental use of telemedicine in HF patients in the context of this or future pandemics and also in situations in which physical consultation might not be possible due to logistic issues. publishersversion published

Cardiovascular diseases represent the first cause of death globally. Inflammatory rheumatic disease (IRMD) patients, due to their lifelong inflammatory status, are at increased risk of developing premature cardiovascular disease. We aimed to assess the risk for cardiovascular events (CVE) in a population-based study. We followed 10,153 adults from the EpiDoC Cohort, a large Portuguese population-based prospective study (2011-2016). IRMD patients were identified at baseline and followed during 5 years. CVE were defined as a composite of self-reported myocardial infarction or angina pectoris, arrhythmias, valvular disease, stroke or transient ischemic attack and peripheral artery disease. Statistical analysis was performed by utilizing multivariate logistic regression and goodness-of-fit and area under ROC curve. At baseline, IRMD patients had similar age as the non-IRMD participants (mean age 55 vs 53 years-old; 72.1% female); dyslipidaemia and sedentary lifestyle were more common (40.7% vs 31.4%, p = 0.033; 87.3% vs 67%, p = 0.016, respectively). During an average follow-up of 2.6 years, 26 CVE were reported among IRMD patients. IRMD patients had higher odd of CVE (OR 1.64, 95% CI 1.04-2.58; p = 0.03), despite comparable mortality rates (1.7% vs 0.7%, p = 0.806). A stepwise approach attained that gender, age, history of hypertension, body mass index, IRMD and follow-up time are the most important predictive variables of CVE (AUC 0.80). IRMD patients, at community level, have an increased short-term risk of major CVE when compared to non-IRMD, and that highlights the potential benefit of a systematic screening and more aggressive cardiovascular risk assessment and management of these patients.

Background Within a sustainable development framework, health is envisioned to integrate across all Sustainable Development Goals (SDGs) as both a precondition and an outcome. Yet, to this day, there is no consensus over which SDG targets are relevant for health and wellbeing. While WHO identified health-related targets across all SDGs, inputs from the academic community are more conservative. Using policy documents (PDs), this study aims to build a comprehensive list of health-related SDG targets for the WHO European Region. Methods PDs endorsed during the 2015-2018 Sessions of the Regional Committee for Europe were selected. A supplementary list of PDs was built reviewing the content of progress reports. 32 PDs were selected following the inclusion criteria of validity and scope. With the collaboration of the Sustainable and Development Programme of WHO EURO, a working list of health-related targets was built. A content analysis of PDs was used to test this list and discover additional targets. Results Outside SDG 3, we identified 55 health-related targets distributed across all SDGs (22 additional to the working list). Emerging fields circumscribed to SDG 2, 4, 5, 10, 11, 12, 13, 16, and 17 - in subjects related to food safety and sustainable production, health and sustainable literacy, social welfare policies, adequate housing, sustainable and inclusive communities, climate change resilience, accountable and effective institutions, participatory decision making, knowledge sharing, operational sciences, and partnerships for sustainable development. Conclusions By performing an analysis beyond the semantics of the SDGs, we constructed a more comprehensive and accurate representation of how health and wellbeing are embodied in the 2030 Agenda. Previous studies have used the explicit content of the SDGs, hindering the possibility to find additional connections. PDs constitute a valuable resource to advance public health within a sustainable development framework. Key messages PDs cross-sectoral approach contribute to understand and acknowledge the connection between health and a variety of non-health topics. Health in the 2030 Agenda relates to targets across all SDGs.

Sub-Saharan African migrants (SAMs) have been disproportionately affected by infectious diseases such as HIV, other sexually transmitted infections (STIs) and Tuberculosis infection (TB). Research on infectious diseases and related factors among migrant populations is critical to further understand these populations' health needs and inform prevention strategies. However, migrants are often underrepresented in national statistics and research. This study aimed to examine correlates of HIV, past STI and past TB among SAMs. A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Uni- and multivariable logistic regression analyses were performed to examine factors associated with HIV, past STI and past TB. Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive increased by age (OR 1.07, 95%CI 1.03-1.11) and were higher among those who experienced violence from a partner (OR 2.77, 95%CI 1.08-7.10). Increased odds of having a past STI were found among migrants with low income (OR 2.86, 95%CI 1.48-5.56), long-term migrants (>25 years residing in Portugal: OR 2.16, 95%CI 1.06-4.38) and those who reported sexual risk behaviors (≥3 sexual partners: OR 2.06, 95%CI 1.14-3.70; inconsistent condom use: OR 2.61, 95%CI 1.32-5.17). In total, 4.1% of participants had TB in the past; these were more likely male (OR 3.42, 95%CI 1.29-9.06) and HIV positive (OR 11.48, 95%CI 4.55-28.94). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past. Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases. Key messages High levels of HIV, STI and TB infection among SAMs were found to be strongly associated with socioeconomic disadvantage and poor living conditions in the host country. Social inequalities are persistently a major factor affecting risk for HIV, STIs and TB, and thus addressing social determinants of infectious diseases must remain a public health priority.

Background Obesity leeds to poor health and may afffect work productivity. We aim to investigate the association between obesity and absenteeism and its indirect costs. Methods Individuals employeed and actively working at baseline form the EpiDoC Cohort, a large portuguese population-based prospective study analized from 2011 to 2016. Body mass index was assessed during baseline appointment. Follow-up assessment was performed through a phone interview and self reported absenteeism defined by the question”did you have a sick leave in previous 12 months? yes/no”, followed by the number of days missed work due to sickness in the previous twelve months.(1) Negative Binomial Regression model estimated the association between obesity and absenteeism. Indirect costs were computed using the human-capital method. Results EpiDoC cohort had 4338 participants who were working adults at baseline. The prevalence of obesity among working adults was 15.2% and of absenteeism was 29.4%. Obesity was associated with an increase in absenteeism incidence rate ratio by 31% (p Conclusions Obesity is an independent risk factor for absenteeism among working adults wich leads to high societal burden in terms of costs. Food and nutrition policies are needed in order improve food patterns and reduce obesity levels among south european population. Key messages Obesity is an independent risk factor for absenteeism among working adults. Obesity increases absenteeism mainly in women and has a major impact on economies.

Issue What has to be done to achieve health equity for migrants? International bodies have published many weighty declarations and recommendations to this end, but these need to be ordered and synthesised. A recurring theoretical problem is how to disentangle the health effects of socioeconomic position (SEP) and migrant status, in order to develop policies that effectively address both factors. Description of the problem As part of the Policy Framework for Analysis (PFA) for Work Package 7 of the Joint Action on Health Equity Europe (JAHEE), key policy documents between 2007 and 2018 were reviewed to form a ‘Road Map' from which a coherent synthesis was extracted. The PFA also developed a model for conceptualising the joint influence of SEP and migrant status. What is the relationship between these, and what policy approaches does it imply? Results The main recommendations of the ‘Road Map' were summarised in two categories: ‘upstream' measures (data collection and research, governance, and intersectoral action to tackle social determinants of health) and ‘downstream' ones (access to health services, responsiveness to migrants' needs, and attention for vulnerable groups). In the past, ‘upstream' measures have been unduly neglected. According to the proposed model, migrant status can have both direct effects on health and indirect ones that are mediated via SEP. Along the indirect pathways, migrants may suffer from increased exposure and/or increased vulnerability to health threats associated with low SEP. Lessons A high degree of consensus already exists about health inequities affecting migrants and the measures needed to tackle them. The urgent challenge at the moment is to put these conclusions into practice. To this end, there is little point in tackling socioeconomic inequities and those linked to migration and ethnicity as though they had nothing to do with each other. Key messages The recommendations of international bodies on migrant health from 2007-2018 can be summarized in three ‘upstream’ measures and three ‘downstream’ ones. Promoting health equity for migrants requires breaking down the silos in which work on migration and on SEP has hitherto been carried out.

For complex public health interventions to be effective their implementation needs to adapt to the situation of those implementing and those receiving the intervention. While context matter for intervention implementation and effect, we still insist on learning from cross-country comparison of implementation. Next methodological challenges include how to increase learning from implementation of complex public health interventions from various context. The interventions presented in this workshop all aims to improve quality of reproductive health care for immigrants, however with different focus: contraceptive care in Sweden, group based antenatal care in France, and management of pregnancy complications in Denmark. What does these interventions have in common and are there cross cutting themes that help us to identify the larger challenges of reproductive health care for immigrant women in Europe? Issues shared across the interventions relate to improved interactional dynamics between women and the health care system, and theory around a woman-centered approach and cultural competence of health care providers and systems might enlighten shared learnings across the different interventions and context. Could the mechanisms of change be understood using theoretical underpinnings that allow us to better generalize the finding across context? What adaption would for example be needed, if the Swedish contraceptive intervention should work in a different European setting? Should we distinguish between adaption of function and form, where the latter might be less important for intervention fidelity? These issues will shortly be introduced during this presentation using insights from the three intervention presentations and thereafter we will open up for discussion with the audience.

Migrants often travel back to the origin countries and to other European states after settling in the residence country. Mobility along with structural vulnerabilities may increase HIV acquisition risk. Knowledge on HIV risk exposure when traveling is limited, yet crucial to inform prevention. This study aims to explore risky sexual behaviors and assess HIV prevalence among sub-Saharan African migrants (SAMs) who travel, residing in two European cities. Two cross-sectional biobehavioral surveys were conducted in Lisbon and Antwerp with a venue-based sample of 1508 SAMs. Descriptive and multivariable logistic regression analyses were performed to examine travel patterns and associated sexual risk behaviors. Overall, 68.4% of participants had traveled to other countries after settling in the residence country; 41% had traveled back to Africa and within Europe, 25.2% only to Africa and 33.8% only to Europe. Among travelers who reported sexual encounters abroad (49.2%), condomless sex at last intercourse was high both abroad (62.5%) and in the host country (70.7%). Odds of condomless sex at the last sexual encounter in the host country were five times higher among those who also reported no condom use abroad [OR: 5.32; 95% CI: 2.98-9.25], controlling for gender, age, educational level, relationship status, survey country, partner type and origin, and number of sexual partners over the last year. Condomless sex was higher with a regular partner and with an African partner, both abroad (79.9% and 67.5%, respectively) and in the host country (81.3% and 74.6%, respectively). Among the 75 participants who tested HIV-positive (around 5%), more than half had travelled to other countries; of these, about half reported condomless sex with their last sexual partner abroad. SAMs are a mobile population and are exposed to sexual HIV risk both while traveling and in host countries. Prevention interventions should address the complex interplay between migrants' mobility and HIV risk. Key messages Migrants often travel to their origin home countries and other destinations after having settled in host countries, and this mobility increases exposure to HIV risk. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants’ HIV risk related to their mobility.

BACKGROUND COVID-19, a viral respiratory disease first reported in December 2019, quickly became a threat to global public health. Further understanding of the epidemiology of the SARS-CoV-2 virus and the risk perception of the community may better inform targeted interventions to reduce the impact and spread of COVID-19. OBJECTIVE In this study, we aimed to examine the association between chronic diseases and serious outcomes following COVID-19 infection, and to explore its influence on people’s self-perception of risk for worse COVID-19 outcomes. METHODS This study draws data from two databases: (1) the nationwide database of all confirmed COVID-19 cases in Portugal, extracted on April 28, 2020 (n=20,293); and (2) the community-based COVID-19 Barometer survey, which contains data on health status, perceptions, and behaviors during the first wave of COVID-19 (n=171,087). We assessed the association between relevant chronic diseases (ie, respiratory, cardiovascular, and renal diseases; diabetes; and cancer) and death and intensive care unit (ICU) admission following COVID-19 infection. We identified determinants of self-perception of risk for severe COVID-19 outcomes using logistic regression models. RESULTS Respiratory, cardiovascular, and renal diseases were associated with mortality and ICU admission among patients hospitalized due to COVID-19 infection (odds ratio [OR] 1.48, 95% CI 1.11-1.98; OR 3.39, 95% CI 1.80-6.40; and OR 2.25, 95% CI 1.66-3.06, respectively). Diabetes and cancer were associated with serious outcomes only when considering the full sample of COVID-19–infected cases in the country (OR 1.30, 95% CI 1.03-1.64; and OR 1.40, 95% CI 1.03-1.89, respectively). Older age and male sex were both associated with mortality and ICU admission. The perception of risk for severe COVID-19 disease in the study population was 23.9% (n=40,890). This was markedly higher for older adults (n=5235, 46.4%), those with at least one chronic disease (n=17,647, 51.6%), or those in both of these categories (n=3212, 67.7%). All included diseases were associated with self-perceptions of high risk in this population. CONCLUSIONS Our results demonstrate the association between some prevalent chronic diseases and increased risk of worse COVID-19 outcomes. It also brings forth a greater understanding of the community’s risk perceptions of serious COVID-19 disease. Hence, this study may aid health authorities to better adapt measures to the real needs of the population and to identify vulnerable individuals requiring further education and awareness of preventive measures.

Background and Aims Survival analysis is a cornerstone in medical research. For this purpose Kaplan-Meier is the most widely used statistical test, but the presence of competing risks violates the fundamental assumption that the censoring mechanism is independent of survival time. This leads to overestimation of the cumulative probability of cause-specific failure. Cumulative incidence estimate and competing risks analysis are preferred. The purpose of this study was to compare different survival analysis methods: Kaplan-Meier and cumulative incidence function estimates in a cohort of Peritoneal Dialysis (PD) patients. Method The survival of 115 incident patients on PD in a university hospital was evaluated after establishing 2 cohorts: patients starting renal replacement therapy with PD (PD first; n=85) and patients switching to PD on the first 6 months of dialysis (PD transfer; n=30). Kaplan-Meier, cumulative incidence function, cause-specific and subdistribution hazards were performed. The event of interest was death and the competing risk events were transfer to hemodialysis and renal transplantation. Results Besides higher residual renal function (RRF) and kt/V in the PD first group, there were no other significant differences between groups. There were 22 deaths. PD first group had a better survival with both Kaplan-Meier (log-rank test, p=0.013) and cumulative incidence function (p=0.021) approaches. The Cox regression model showed, as protecting variables, higher albumin (HR=0.174; CI95% 0.054-0.562), higher RRF (HR=0.785; CI95% 0.666-0.925) and PD first (HR=0.350; CI95% 0.132-0.927). Higher Charlson Index predicted worse outcome (HR=1.459; CI95% 1.159-1.835). PD as first dialysis therapy was associated with 65.0 % lower risk of death comparing with PD transfer. The subdistribution multivariable model found higher Charlson Index (HR=1.389; CI95% 1.118-1.725) and lower RRF (HR=0.798; CI95% 0.680-0.936) were statistically associated with death, but not PD transfer or albumin. This result differs from the obtained using the cause-specific hazard model. Analyzing the competing events, patients submitted to renal transplantation had a lower Charlson Index. Conclusion The probability of death was overestimated by the Kaplan-Meier method. The bias of Kaplan-Meier is especially great when the hazard of the competing risks is large. This study consisted on a statistical critical analysis of a real medical example, broader clinical conclusions related with “PD first initiative” should be cautious in this context. It is primordial to recognize the presence of competing risks in studies with multiple outcomes, as in Peritoneal Dialysis studies, to estimate cumulative incidence and yield more accurate results. This study shows how different conclusions are attained with different statistical methodology and its relevance in clinical context.

A 14-Item Mediterranean Diet Adherence Screener (MEDAS) questionnaire was developed and validated in face-to-face interviews, but not via telephone. The aims of this study were to evaluate the validity and reliability of a telephone-administered version of the MEDAS as well as to validate the Portuguese version of the MEDAS questionnaire. A convenience community-based sample of adults (n = 224) participated in a three-stage survey. First, trained researchers administered MEDAS via a telephone. Second, the Portuguese version of Food Frequency Questionnaire (FFQ), and MEDAS were administered in a semi-structured face-to-face interview. Finally, MEDAS was again administered via telephone. The telephone-administered MEDAS questionnaire was compared with the face-to-face-version using several metrics. The telephone-administered MEDAS was significantly correlated with the face-to-face-administered MEDAS [r = 0.805, p &lt, 0.001, interclass correlation coefficient (ICC) = 0.803, p &lt, 0.001] and showed strong agreement (k = 0.60). The MEDAS scores that were obtained in the first and second telephone interviews were significantly correlated (r = 0.661, p &lt, ICC = 0.639, p &lt, 0.001). The overall agreement between the Portuguese version of MEDAS and the FFQ-derived Mediterranean diet adherence score had a Cohen&rsquo, s k = 0.39. The telephone-administered version of MEDAS is a valid tool for assessing the adherence to the Mediterranean diet and acquiring data for large population-based studies.

The original version of this article, published on 02 March 2020, unfortunately contained an error on “Fig. 3 Prevalence of Vitamin D Levels by NUTSII.”

Introdução: Bonanno definiu resiliência como a capacidade do indivíduo em lidar com os eventos traumáticos, nomeadamente a capacidade de manter os níveis de funcionamento físico e psicológico relativamente estáveis. O objetivo do estudo foi avaliar as propriedades psicométricas da escala de resiliência Connor-Davidson de 10 itens. A escala resumida apresenta boas qualidades psicométricas (α Cronbach – 0,85) quando comparada com a escala longa (25 itens) (α Cronbach – 0,89). Material e Métodos: Obtivemos uma amostra de conveniência de inscritos em centros de emprego que foi aleatoriamente dividida em duas subamostras (amostra 1 = 5127 e amostra 2 = 5134). Aplicámos a análise de componentes principais na amostra 1. Com a amostra 2 procedeu-se à análise fatorial confirmatória usando o método da máxima verosimilhança. Usámos a análise multigrupo para a comparação do modelo fatorial entre os géneros e a situação profissional. Efetuámos a análise convergente e divergente através da análise de correlação de Pearson. Resultados: A análise de componentes principais extraiu um fator com uma variância explicada de 53,97%. A análise fatorial confirmatória comprovou a unidimensionalidade da escala. Confirmámos a invariância entre géneros e situação profissional. A escala de resiliência Connor-Davidson de 10 itens correlacionou-se positivamente com as medidas da escala SF-36 e negativamente com a escala GHQ-12. Discussão: A análise exploratória e confirmatória corroborou a unidimensionalidade e boas propriedades psicométricas, semelhantes à escala original de 10 itens. Conclusão: Trata-se do primeiro estudo de validação desta escala na população portuguesa (Portugal), de acordo com a pesquisa efetuada. Os seus resultados são muito satisfatórios, recomendando-se o seu uso na população portuguesa. info:eu-repo/semantics/publishedVersion

Portuguese adults have a long lifespan, but it is unclear whether they live a healthy life in their final years. We aimed to determine the prevalence of multimorbidity and characterize lifestyle and other health outcomes among older Portuguese adults.We performed a cross-sectional evaluation of 2393 adults, aged 65 and older, during the second wave of follow-up of the EpiDoC cohort, a population-based study involving long-term follow-up of a representative sample of the Portuguese population. Subjects completed a structured questionnaire during a telephone interview. Socioeconomic, demographic, lifestyle behaviours, chronic diseases, and health resources consumption were assessed. Cluster analysis was done to identify dietary patterns. Descriptive and analytic analysis was performed to estimate multimorbidity prevalence and its associated factors.Multimorbidity prevalence among older adults was 78.3%, increased with age strata (72.8% for 65 - 69 years to 83.4% for ≥ 80 years), and was highest in Azores (84.9%) and Alentejo (83.6%). The most common chronic diseases were hypertension (57.3%), rheumatic disease (51.9%), hypercholesterolemia (49.4%), and diabetes (22.7%). Depression symptoms were frequent (11.8%) and highest in the oldest strata. The mean health-related quality of life (EQ-5D-3L) score was 0.59 ± 0.38. Hospitalization in the previous 12 months was reported by 25.8% of individuals. Overall, 66.6% of older adults were physically inactive. 'Fruit and vegetables dietary pattern' was followed by 85.4% of individuals; however, regional inequalities were found (69% in Azores). Obesity prevalence was 22.3% overall and was highest among Azoreans (33%).The high prevalence of multimorbidity, combined with unhealthy lifestyle behaviours, suggests that the elderly populationconstitutes a vulnerable group warranting dedicated intervention.Introdução: A esperança de vida está a aumentar em Portugal, contudo desconhece-se o estado de saúde dos idosos. Pretende-se determinar a prevalência de multimorbilidade, caracterizar estilos de vida e outros fatores relacionados com a saúde dos idosos. Material e Métodos: Efetuou-se uma avaliação transversal a 2393 adultos com 65 ou mais anos de idade, da coorte EpiDoC que é constituída por uma amostra representativa da população portuguesa. Os inquiridos responderam a um questionário estruturado através de uma entrevista telefónica, tendo-se recolhido dados socioeconómicos demográficos, estilo de vida, doenças crónicas e consumo de recursos em saúde. Análise de clusters foi realizada para a identificação de padrões alimentares. Efetuou-se análise descritiva e analítica para estimar a prevalência de multimorbilidade e fatores associados. Resultados: A prevalência de multimorbilidade nos idosos foi de 78,3% (72,8% entre os 65 - 69 anos, 83,4% com 80 + anos) e foi superior nos Açores (84,9%) e no Alentejo (83,6%). As doenças crónicas mais prevalentes foram a hipertensão arterial (57,3%), doenças reumáticas (51,9%), hipercolesterolemia (49,4%) e diabetes (22,7%). Os sintomas de depressão (11,8%) foram frequentes, aumentando ao longo dos grupos etários. A qualidade de vida (EQ-5D-3L) foi em média de 0,59 ± 0,38 e 25,8% dos idosos reportaram ter sido hospitalizados nos 12 meses prévios à entrevista. Cerca de 66,6% dos idosos são fisicamente inativos. O padrão alimentar caracterizado por ‘+ fruta e + hortícolas’ foi reportado por 85,4% dos idosos, contudo foram encontradas iniquidades regionais (69% para os idosos açorianos). A prevalência de obesidade foi de 22,3%, sendo superior nos açorianos (33%). Conclusões: A elevada prevalência de multimorbilidade combinada com estilos de vida pouco saudáveis sugere que a população idosa constitui um grupo vulnerável que requer uma intervenção direcionada.

Background The HIV/AIDS Programme has been a core health programme in Portugal leading the country’s response to the HIV epidemics since the 1980s. In 2011, the severe financial and economical context forced the government to reorganize central services, including the Ministry of Health, aiming to improve efficiency and reduce costs. All vertical programmes were reformed, including the HIV/AIDS Programme. Methods For the period 2009-2018, we analyse the outcomes of core HIV prevention programmes managed by the National Programme for HIV/AIDS Infection: the syringe exchange programme, HIV testing, the distribution of preventive materials, and financial support to private non-for-profit organisations. Results This paper describes the main features of that reform and analyses selected outcomes, as well as how those financial constraints affected the response to HIV/AIDS. Despite some transitory cuts in spending, the National Programme for HIV/AIDS Infection was able to successfully expand testing and prevention interventions. Strategic partnerships with non-governmental and community-based organisations were crucial to continue delivering adequate HIV testing services and reaching most-at-risk groups. Conclusions The main goals of the National Programme for HIV/AIDS Infection for the term 2012-2016 were reached, including the decrease of new HIV infections, new AIDS cases and AIDS-related deaths, and the country is in a good position to meet UNAIDS’s 90-90-90 targets by 2020. Scaling-up access to pre-exposure prophylaxis, improving access and adherence to antiretroviral therapy, and continuously promoting access to HIV testing services and HIV self-testing stand as the main challenges of the National Programme for HIV/AIDS Infection in the near future. Key messages Prioritise spending under financial constrains can be cost-effective. Besides transitory cuts, HIV programme was able to meet its goals.

Issue The Joint Action on Health Equity in Europe (JAHEE) aims to address inequities in health across all groups. Work Package 7 Migration and Health (WP7) includes 13 partner countries and focuses on health inequities affecting the migrant population. The project started out by developing Policy Framework for Action (PFA), intended to form the basis for exploring opportunities for appropriate actions in the three-year implementation period of the action. The PFA formulated a ’road map’ encompassing six priorities identified in 22 ’soft policy’ documents that have been published by international /governmental organisations since 2007. It also discussed the state of the art in research on the causes of particular inequities undermining migrant health, as well as the measures that can be taken to tackle them. Description of the problem The main objective of the Country Assessments (CAs) is to identify the best opportunities (entry points) for developing country-specific actions. From this list, actions will be selected and implemented that are feasible within the constraints of JAHEE. The CAs will provide the information partners need in order to make informed choices. The assessments will indicate where the most serious inequities lie, what causes them, and what can be done about them. The CA Template was based on the PFA, reviewed by the Expert Group and then piloted in two countries (Norway and Italy) in March 2019. The 13 partners participating in WP7 are currently carrying out their assessments, which will be completed by July 2019. Results An overview of the main results of the CAs will be presented at the conference. Lessons Developing and piloting the Country Assessment Template has been participatory, with necessary revisions on the basis of experience. Completing these assessments for each participant is in itself is the first step towards action. Participants create an overview of available data, experiences and gaps in their countries. Key messages The Country Assessment Template is a tool that enables partners to take stock of the situation in their country. Analysis of data from the assessments will enable countries to make an appropriate choice of actions.

To evaluate the effectiveness on lifestyle change of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower) and to analyse the predictors of the mHealth intervention effectiveness.This study is designed as a non-randomized controlled trial with a two-arm structure.Adolescents of 12-16-year old were recruited from three school districts, with access to the Internet and smartphone/tablet devices. The intervention group was invited to engage in the mHealth intervention (TeenPower) for 6 months in addition to a school-based intervention. The control group only followed the school-based intervention. A repeated measures factorial ANOVA was used and the main effectiveness outcome was the lifestyle change measured by the adolescent lifestyle profile.The outcomes of the mHealth intervention (TeenPower) show a significant effect on nutrition (ƞAlthough the considerable dropout rate, the mHealth intervention presented significant impact on multiple lifestyle domains, providing support for the effectiveness of mHealth interventions for health promotion as an add-on to standard interdisciplinary interventions.Adolescents must have the necessary and appropriate knowledge for the correct and responsible decision-making regarding their health and lifestyle. Innovative strategies (mHealth intervention) were used to promote healthy behaviours. This study evaluates the effectiveness of an mHealth intervention (TeenPower) specifically designed for adolescents. We found a significant impact in several lifestyle domains such as health responsibility, nutrition, positive life perspective, and global lifestyle.目的: 评价促进青少年健康行为的移动医疗(mHealth)干预对生活方式改变的作用,并分析移动医疗(mHealth)干预有效性的相关因素。 设计: 该研究被设计为一项非随机对照试验(两组结构)。 方法: 从三个学区招募了12岁~16岁的青少年,他们可以使用互联网和智能手机/平板电脑设备。除接受学校干预外,干预组还接受为期6个月的移动医疗(mHealth)(TeenPower)。对照组仅接受学校干预。采用因素方差分析(factorial ANOVA)重复测量,并且主要影响结果是青少年生活方式发生变化。 结果: 移动医疗(mHealth)干预(TeenPower)的结果显示对营养(ƞ2 p = 0.03, p = .03)、积极生活观(ƞ2 p = 0.04, p = .01)和全球生活方式(ƞ2p = 0.02, p = .05)有显著影响,退学率为62.1%。对移动医疗(mHealth)干预有效性相关因素的分析表明,年龄稍大的青少年的心理压力管理率有显著提高的趋势(r=.40;p.05)。 结论: 尽管退学率相当高,但移动医疗(mHealth)干预对多个生活方式领域产生了重大影响,支持移动医疗(mHealth)干预作为附加的标准跨学科干预手段对促进健康的有效性。 影响: 青少年必须具备必要和适当的知识,能够作出与其健康生活方式相关的正确且负责任的决定。创新策略(mHealth干预)用于促进健康行为。该研究评估了专为青少年设计的健康干预(TeenPower)的有效性。我们发现,该等干预在诸如健康责任、营养、积极生活观和全球生活方式等生活方式领域有着重大影响。.

Vitamin D deficiency is prevalent worldwide, but its prevalence is unknown in adult Portuguese population. In Portugal, 66% of adults present Vitamin D insufficiency/deficiency. Winter, living in Azores, older age, and obesity were the most important risk factors. It highlights the need of strategies to prevent vitamin D deficiency in Portugal.To estimate the prevalence and risk factors of vitamin D deficiency in the adult Portuguese population.Adults (≥ 18 years old) from the EpiReumaPt Study (2011-2013) were included. Standardized questionnaires on socio-demographic and lifestyle features were obtained. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were evaluated using ADVIA Centaur VitD competitive immunoassay (Siemens Healthineers) in 2015-2017 as 25 (OH)D Level 0: ≤ 10 ng/mL; Level 1: 11-19 ng/mL; Level 2: 20-29 ng/mL, and Level 3: ≥ 30 ng/mL. Weighted multinomial regression analysis was conducted to evaluate the association between socio-demographic and lifestyle variables and vitamin D status.Based on weighted analysis, the estimated prevalence of levels of 25(OH)D ≤ 10, 20, and 30 ng/mL was 21.2, 66.6, and 96.4%, respectively. The strongest independent predictors of serum 25 (OH)D ≤ 10 ng/mL were living in the Azores archipelagos (OR 9.39; 95%CI 1.27-69.6) and having the blood sample collection in winter (OR 18.53; 95%CI 7.83-43.87) or spring (11.55; 95%CI 5.18-25.74). Other significant predictors included older age (OR 5.65, 95%CI 2.08-15.35), obesity (OR 2.61; 95%CI 1.35-5.08), current smoking (OR 2.33; 95%CI 1.23-4.43), and female gender (OR 1.9, 95%CI 1.1-3.28). Conversely, physical exercise (OR 0.48, 95%CI 0.28-0.81) and occasional alcohol intake (OR 0.48, 95%CI 0.29-0.81) were associated with a lower risk of 25(OH)D ≤ 10 ng/mL.Vitamin D deficiency/insufficiency [25(OH)D 20 ng/ml] is highly prevalent in Portugal, affecting 60% of all Portuguese adults, with strong geographical and seasonal variation. This study highlights the need to critically assess the relevance of vitamin D deficiency as a public health problem and the urgent need for a wide and scientifically robust debate about the most appropriate interventions at the individual and societal levels.

Background: Hand osteoarthritis (HOA) is a highly prevalent rheumatic disease that predominates in females and causes pain, joint deformities and loss of functional capacity. Overweight and metabolic syndrome have been previously suggested to associate with the severity of HOA, but clarity on these associations is yet to be achieved. Objectives: To test the possible association between body mass index (BMI) and other individual components of metabolic syndrome with severity of HOA in females from a nationwide epidemiological study. Methods: EpiReumaPt was a three-stage national health survey where, in the first phase, 10,661 adult participants were randomly selected and interviewed using a structured face-to-face questionnaire that included screening for rheumatic diseases, such as HOA. In the second phase, positive screenings for ≥1 rheumatic complaint plus 20% of the negative screenings were invited for an assessment by rheumatologists. Finally, 3 rheumatologists revised all the information and defined the final diagnosis by consensus. Female patients with a final clinical diagnosis of primary HOA were included in this analysis. Hand functional status as assed by the Cochin questionnaire was the outcome of interest. The explanatory variables of interest were: BMI evaluated as a categorical variable (Normal: 18-24.99; overweight: 25-29.99; obesity: ≥ 30), diabetes mellitus, hypertension and hypercholesterolemia (all self-reported and as binary variables: yes/no). The possible associations between BMI and the individual components of the metabolic syndrome with the Cochin score were tested in a multivariable linear regression model. Only significant variables (p Results: Out of the 3,877 participants evaluated by Rheumatologists, 473 women had primary HOA (national prevalence: 6.6%). In this population, 40% were overweight and 29% were obese. Ninety-three (20%) participants had diabetes, 261 (56%) had hypertension and 261 (56%) had hypercholesterolemia. In the multiple regression model, BMI and diabetes were found to significantly associate with HOA severity, whereas hypertension and hypercholesterolemia did not, thus not being selected in the final model (table). Conclusion: In this study, higher BMI and the presence of diabetes mellitus associated with a worse functional capacity in women with primary HOA. These data add to the body of evidence suggesting a possible role of metabolic factors in the severity of HOA. References: [1] Yusuf E, Nelissen RG, Ioan-Facsinay A et al. Association between weight or body mass index and hand osteoarthritis: a systematic review. Ann Rheum Dis 2010. 69: 761-765 [2] Schett G, Kleyer A, Perricone C et al. Diabetes is an independent predictor for severe osteoarthritis: results from a longitudinal cohort study. Diabetes Care 2013; 36: 403-409 Acknowledgement: The authors thank all the participants of EpiReumaPt survey, the interviewers and staff and the Rheumatologists that worked in the field Disclosure of Interests: Margarida Cruz: None declared, Alexandre Sepriano: None declared, Sara Dias: None declared, Ana Maria Rodrigues: None declared, Helena Canhao: None declared, Nelia Gouveia: None declared, Monica Eusebio: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant for: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Jaime Branco: None declared

Although eradicated in Portugal, malaria keeps taking its toll on travellers and migrants from endemic countries. Completeness of hospital requiring malaria notification in Portugal 2000-11 was estimated, using two-source capture-recapture method. Data sources were: national surveillance database of notifiable diseases and the national database of the Diagnosis-Related Groups resulting from National Health Service (NHS) hospital episodes. The completeness of notification was 21,2% for all malaria cases and 26,5% for malaria deaths, indicating significant underreporting and urging for complementary data source in surveillance, for disease burden estimates and retrospective monitoring, namely hospital episodes statistics.

Aim: This paper describes the design and rationale of multicenter practice-based research that aims to develop and evaluate an innovative mobile health (mHealth) intervention programme directed to promote healthy behaviours and prevent adolescent obesity. Design: This study is designed as a non-randomized controlled trial with a three-arm structure. Methods: Twelve to 16 years old participants will be recruited from schools, with access to the Internet and smartphone/tablet devices. The intervention group will be invited to engage in the TeenPower mHealth programme and divided into two subgroups: Group A (additionally engaged in a structured school-based intervention programme) and Group B (only engaged in the mHealth programme). The mHealth app includes educational resources, self-monitoring, social support, interactive training modules and motivational tools. The control group will only follow the structured school-based intervention programme. The intervention length will be 3 months, including the direct support of an interdisciplinary team (nursing, nutrition, sports, psychology, among others). This research was approved and funded in August 2017. Discussion: The positive evaluation of the intervention programme will stimulate the inclusion of technologies in the promotion of salutogenic behaviours and obesity prevention. Impact: Adolescent obesity reached epidemic proportions. It is urgent to find effective prevention strategies to induce change at the individual, family and community level. If effective, this protocol can be used by health and exercise professionals in improving community interventions tailored to teenagers.

The use of population-based survey data together with sound statistical methods can enhance better estimation of HIV risk factors and explain variations across subgroups of the population. The distribution and determinants of HIV infection in populations must be taken into consideration. We analysed data from the HIV Prevalence and Behaviour Survey in Mozambique aiming to find risk factors associated with HIV infection among Mozambican women. The paper provides a complex survey logistic regression model to explain the variation in HIV seropositivity using demographic, socio-economic and behavioural factors. Results show that women aged 25–29 years, living in female-headed households, living in richer households and those widowed, divorced or not living with a partner have higher odds of being HIV-positive. Findings from our study provide a unique and integrated perspective on risk factors for being HIV-positive among Mozambican women and could support the implementation of programmes aiming to reduce HIV infection in Mozambique.Keywords: complex survey, HIV/AIDS, HIV/AIDS knowledge and attitudes, logistic regression, Mozambican women

Background: Adequate sleep is essential for health. Both, short and long sleep durations are associated to worse quality of life and poor health outcomes. Portugal represents a specific population model, since according to European statistics it has high rates of chronic diseases like depression, hypertension, diabetes and stroke; and low quality of life as well as low index of physical activity, while in parallel it has some other good health indicators such as: low age-standardized mortality for both genders, nutrition in terms of energy and fruit consumption, smoking and alcohol, obesity and overweight prevalence. The aim of this study was to characterize health and chronic diseases, lifestyles and quality of life in subjects with short and long sleep duration. Methods: A populationbased cross-sectional evaluation of the third wave of follow-up of the EpiDoC Cohort was carried between 2015-2016. A sample of 5,436 adults ≥18 years, representative of the national population, self-reported their daily total sleep time. Associations between short sleep duration (SSD ≤5h), long sleep duration (LSD≥9h) and independent variables were determined. Results: The prevalence for SSD was high (20.7%) and the LSD (5.9%) was low. Being older, with lower education, retired and unemployed were associated to SSD and LSD (p

Costs with HIV/AIDS hospitalizations are one of the major financial burdens on healthcare systems worldwide. In Portugal, hospitalizations related to HIV infection are some of the most expensive and the second major diagnosis category, and also accounts for the greatest average length of stay. As a result, it is crucial to understand and identify HIV/AIDS hospital length of stay outliers. The objective of this study is to analyse HIV/AIDS length of stay high outliers during five consecutive years (2009-2013) and to identify its determinants for a specific HIV/AIDS diagnosis related group. To attain these objectives we will use a logistic regression model with random effects.