Spatio-temporal trends of the age-at-menarche percentiles among Portuguese women since 1920.

BACKGROUND: This work aims to study the spatio-temporal evolution of a woman's age at menarche in the central region of Portugal. One of the concerns of the study is early or late menarches; thus, we consider percentile regression to build the respective curves as opposed to the more traditional mean regression approach. METHODS: We analysed the data from [Formula: see text] women born in the period 1920-1973 who attended a free breast cancer screening program between 1990 and 2019. Distributional regression models inside the package GAMLSS in R were considered. These methods allowed us not only to model the location (mean) of the specific probability distribution of the age at menarche, but also allowed for the scale (variance) parameter of this distribution to depend on covariates. Additionally, a spatial random-effect was considered in order to capture the correlation at the regional level. The obtained clustered spatial effects were analysed to assess geographical differences among the percentiles of the age at menarche by year of birth. RESULTS: A decreasing trend in the age at menarche (about 1.5 years in 5 decades) and regional differences for all the considered percentiles were found. Women living in the north-central areas of the central region of Portugal tend to have menarche at older ages. CONCLUSION: We obtained percentile estimates for the age at menarche by year of birth and region of residence and demonstrated that these two explanatory variables have an impact on the explanation about the decreasing trend in age at a woman's first menstruation.

Economic strain and quality of life among families with emerging adult children: The contributions of family rituals and family problem-solving communication.

Young people and their families around the world are especially vulnerable to macroeconomic hard times. This study sought to provide a more comprehensive view on how families with emerging adult children can successfully overcome economic distress. Specifically, we examined the links between economic strain-that is, the subjective perceptions of one's current and future financial situation-family ritual meaning, family problem-solving communication, and quality of life, as reported by emerging adults and their parents. Data were collected from 1017 individuals nested in 334 families living in Portugal in 2016/2017. Results from multilevel modeling provided evidence for a negative impact of economic strain on family members' quality of life (ß = -0.30, p < 0.001); and for the role of family ritual meaning (ß = 0.01, p = 0.022), but not family problem-solving communication, as a buffer against the negative effect of economic strain on quality of life. Findings also suggested that the subjective evaluations that family members formulated about their financial situations played a greater role than objective economic conditions (e.g., income) in establishing a deeper understanding on the impact of economic demands on individuals and families' lives in today's complex financial world. This study provides a significant contribution to family economic stress research, advancing family ritual meaning as a key family dynamic contributing to positive adaptation to economic distress. The implications of these findings for clinical interventions include the potential benefits of symbolic forms of family communication in the work carried out with economically stressed family members.

A temporal analysis on patient and health service delays in pulmonary tuberculosis in Portugal: inter and intra­regional differences and in(equalities) between gender and age.

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

Histoplasmosis tenosynovitis of the forearm and wrist: imaging, surgical and pathologic findings.

Histoplasmosis is a disease endemic to several parts of the world, including South America. It progresses in a mostly asymptomatic and self-limiting manner but has the potential to cause disseminated pulmonary infection, especially in immunocompromised patients. Rare reports from the literature describe musculoskeletal manifestations related to the two varieties of the pathogen that cause histoplasmosis, namely, the capsulatum or duboissi variety. In this report, we describe the case of a previously healthy, middle-aged man, with slowly progressing pain in the right forearm, wrist, and fingers, diagnosed with a case of pathologically confirmed histoplasmosis tenosynovitis. We also describe the imaging, surgical, and histological findings and discuss the differential diagnoses for tenosynovitis, in case of atypical infections.

Spanish-Speaking Therapists Increasingly Switch to Telepsychology During COVID-19: Networked Virtual Reality May Be Next.

Background: Social distancing restrictions imposed due to the Novel Coronavirus 2019 (COVID-19) pandemic resulted in a rapid shift in the delivery of psychological interventions from in-person to telehealth. Much of the research on this transition has been conducted with English-speaking mental health providers, leaving a gap in understanding related to how this shift has impacted Spanish-speaking treatment providers. Methods: Fifty non-U.S. Spanish-speaking therapists completed a survey related to their use of telecommunication modalities; client population characteristics; professional, ethical, and legal/regulatory issues; and telehealth training and practice. Participants completed the survey at one time point and retrospectively described their use of telehealth both pre-pandemic and during the pandemic. Results: Most of the 50 Spanish-speaking therapists surveyed reported using telepsychology 58% before COVID-19 versus 84% during the COVID-19 pandemic (χ2 = 5.76, p < 0.05). Compared with pre-pandemic, the number of hours therapists spent using telepsychology per week increased significantly for early adopter therapists (those who began using telehealth before the pandemic began) (Z = -3.18, p = 0.001) and also for late adopter therapists who only began using telehealth during the pandemic (Z = -3.74, p < 0.001). Many therapists reported equity issues. Most participants also reported ethical and regulatory concerns regarding security/confidentiality or Health Insurance Porability and Accountability Act. Conclusions: The rapid adoption of technology to deliver therapy during COVID-19 has spurred growing pains for Spanish-speaking therapists and their underserved clients, and more research is needed to better understand and improve the therapists' adoption of these technologies with diverse patient populations.

Detection of anti-Pneumocystis jirovecii antibodies in human serum using a recombinant synthetic multi-epitope kexin-based antigen.

Interest in the detection of specific anti-Pneumocystis jirovecii antibodies has emerged as less-invasive alternative diagnostic approaches. Here is presented the performance of an ELISA based on a recombinant synthetic multi-epitope kexin 1 (Kex1) antigen of P. jirovecii, previously developed. Results showed that IgM anti-Kex1 levels were found significantly increased in patients with Pneumocystis pneumonia (PcP) compared with non-PcP cases (p < 0.001), allowing a diagnostic performance of PcP with a 70.8% sensitivity and a 75.0% specificity. These results suggest that this Kex1-based ELISA is a promising tool toward the serodiagnosis of PcP when the standard methods are difficult to perform.

A single dose of purple grape juice improves physical performance and antioxidant activity in runners: a randomized, crossover, double-blind, placebo study.

PURPOSE: To investigate the effects of a single dose of juice on physical performance, oxidative stress, inflammation and muscle damage in runners. METHODS: Fourteen recreational male runners (39 ± 9 years, VO2peak = 55.9 ± 6.5 ml/kg/min) performed two running tests to exhaustion at 80% of VO2max after ingesting grape juice or a placebo drink (10 ml/kg/day) randomly. Blood samples were taken before and 2 h after supplementation and immediately after running to analyze total antioxidant capacity (TAC), malondialdehyde (MDA), alpha-1 acid glycoprotein (A1GPA), high-sensitivity C-reactive protein (hs-CRP), creatine kinase (CK) and lactate dehydrogenase (LDH). RESULTS: The participants ran for an average of 59.2 ± 27.8 min until exhaustion in the placebo group and for 68.4 ± 29.7 min until exhaustion in the grape juice intake group, which was a significantly longer time (p = 0.008). This improvement in physical performance was accompanied by a 43.6% increase in TAC (p = 0.000) at the post-exercise timepoint compared to the level at baseline. MDA, A1GPA, hs-CRP, CK, and LDH did not exhibit changes. In contrast, no significant change in any variable was observed after consuming the placebo drink. CONCLUSION: The single-dose intake of purple grape juice demonstrated an ergogenic effect in recreational runners by increasing run time to exhaustion and increasing antioxidant activity.

Breastfeeding and neurodevelopmental outcomes.

PURPOSE OF REVIEW: Breastfeeding has clear short-term benefits for child survival. Concerning its long-term consequences, it has been reported that subjects who had been breastfed would have a better performance in intelligence tests. In this review, we perused the recently published studies on the association of breastfeeding with developmental outcomes. RECENT FINDINGS: A meta-analysis published in 2015 reported that intelligence quotient (IQ) was 3.44 points (95% confidence interval: 2.30; 4.58) higher among subjects who had been breastfed, and this association was observed even among those studies that controlled for maternal IQ. In the present review, we identified two studies that reported that duration of breastfeeding was positively associated with IQ in childhood, whereas another study reported that cognitive score at 67.9 years of age was higher among those subjects who had been breastfed for at least 6 months. Furthermore, two studies reported that the small gain in IQ was associated with higher school achievement and income in adulthood. Concerning the possible mechanisms for the effect of breastfeeding on development, children who had been breastfed showed greater gray matter volume in the left and right parietal and left temporal lobes and more activation in the right frontal and temporal lobes for perception tasks, whereas for the language task, the activation was higher in the left temporal lobe. Moreover, it has been reported that subcortical gray matter volume mediated the association between breastfeeding and IQ. SUMMARY: The new studies identified in the review reinforce the evidence that breastfeeding has long-term consequences on performance in intelligence tests. In addition, this association between breastfeeding and development has long-term consequences on human capital, increasing earning ability.

Malaria determining risk factors at the household level in two rural villages of mainland Equatorial Guinea.

BACKGROUND: After the introduction of an artemisinin-based combination therapy, the reduction of prevalence of malaria infections has shown a remarkable progress during the last decade. However due to the lack of a consistent malaria control programme and socioeconomic inequalities, Plasmodium infection is still one of the major cause of disease in Equatorial Guinea, namely in the rural communities. This study explored the associated risk factors of malaria transmission at the microeconomic level (households) in two rural villages of mainland Equatorial Guinea. METHODS: This survey involved 232 individuals living in 69 households located in two rural villages, Ngonamanga and Miyobo, of coastal and interior of Equatorial Guinea, respectively. Malaria prevalence was measured by PCR and parasitaemia level by optical microscopy; household socioeconomic status (SES) was measured based on house characteristics using a 2-step cluster analysis. Logistic regression analysis was performed to investigate the relationship of a diverse set of independent variables on being diagnosed with malaria and on showing high levels of parasitaemia. RESULTS: The prevalence of Plasmodium spp. infection was 69%, with 80% of households having at least one parasitaemic member. The majority of houses have eaves (80%), walls of clay/wood (90%) and zinc roof (99%) and only 10% of them have basic sanitation facilities. The studied areas showed reduced rates of indoor residual spraying coverage (9%), and long-lasting insecticide-treated net ownership (35%), with none of these preventive tools showing any significant effects on malaria risk in these areas. Neither the risk of malaria infection (PCR positive result) or the development of high parasitaemia did show association with SES. CONCLUSIONS: This study has contributed to reinforce the importance of living conditions associated to a high risk of malaria infection and vulnerability to develop high parasitaemia. This study also contributes to future malaria control interventions to be implemented in mainland Equatorial Guinea or in other countries with similar environmental conditions.

Plasmodium falciparum Genetic Diversity in Continental Equatorial Guinea before and after Introduction of Artemisinin-Based Combination Therapy.

Efforts to control malaria may affect malaria parasite genetic variability and drug resistance, the latter of which is associated with genetic events that promote mechanisms to escape drug action. The worldwide spread of drug resistance has been a major obstacle to controlling Plasmodium falciparum malaria, and thus the study of the origin and spread of associated mutations may provide some insights into the prevention of its emergence. This study reports an analysis of P. falciparum genetic diversity, focusing on antimalarial resistance-associated molecular markers in two socioeconomically different villages in mainland Equatorial Guinea. The present study took place 8 years after a previous one, allowing the analysis of results before and after the introduction of an artemisinin-based combination therapy (ACT), i.e., artesunate plus amodiaquine. Genetic diversity was assessed by analysis of the Pfmsp2 gene and neutral microsatellite loci. Pfdhps and Pfdhfr alleles associated with sulfadoxine-pyrimethamine (SP) resistance and flanking microsatellite loci were investigated, and the prevalences of drug resistance-associated point mutations of the Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps genes were estimated. Further, to monitor the use of ACT, we provide the baseline prevalences of K13 propeller mutations and Pfmdr1 copy numbers. After 8 years, noticeable differences occurred in the distribution of genotypes conferring resistance to chloroquine and SP, and the spread of mutated genotypes differed according to the setting. Regarding artemisinin resistance, although mutations reported as being linked to artemisinin resistance were not present at the time, several single nucleotide polymorphisms (SNPs) were observed in the K13 gene, suggesting that closer monitoring should be maintained to prevent the possible spread of artemisinin resistance in Africa.

Studying the relationship between a woman's reproductive lifespan and age at menarche using a Bayesian multivariate structured additive distributional regression model.

Studies addressing breast cancer risk factors have been looking at trends relative to age at menarche and menopause. These studies point to a downward trend of age at menarche and an upward trend for age at menopause, meaning an increase of a woman's reproductive lifespan cycle. In addition to studying the effect of the year of birth on the expectation of age at menarche and a woman's reproductive lifespan, it is important to understand how a woman's cohort affects the correlation between these two variables. Since the behavior of age at menarche and menopause may vary with the geographic location of a woman's residence, the spatial effect of the municipality where a woman resides needs to be considered. Thus, a Bayesian multivariate structured additive distributional regression model is proposed in order to analyze how a woman's municipality and year of birth affects a woman's age of menarche, her lifespan cycle, and the correlation of the two. The data consists of 212,517 postmenopausal women, born between 1920 and 1965, who attended the breast cancer screening program in the central region of Portugal.

Synthetic organotelluride compounds induce the reversal of Pdr5p mediated fluconazole resistance in Saccharomyces cerevisiae.

BACKGROUND: Resistance to fluconazole, a commonly used azole antifungal, is a challenge for the treatment of fungal infections. Resistance can be mediated by overexpression of ABC transporters, which promote drug efflux that requires ATP hydrolysis. The Pdr5p ABC transporter of Saccharomyces cerevisiae is a well-known model used to study this mechanism of antifungal resistance. The present study investigated the effects of 13 synthetic compounds on Pdr5p. RESULTS: Among the tested compounds, four contained a tellurium-butane group and shared structural similarities that were absent in the other tested compounds: a lateral hydrocarbon chain and an amide group. These four compounds were capable of inhibiting Pdr5p ATPase activity by more than 90%, they demonstrated IC50 values less than 2 µM and had an uncompetitive pattern of Pdr5p ATPase activity inhibition. These organotellurides did not demonstrate cytotoxicity against human erythrocytes or S. cerevisiae mutant strains (a strain that overexpress Pdr5p and a null mutant strain) even in concentrations above 100 µM. When tested at 100 µM, they could reverse the fluconazole resistance expressed by both the S. cerevisiae mutant strain that overexpress Pdr5p and a clinical isolate of Candida albicans. CONCLUSIONS: We have identified four organotellurides that are promising candidates for the reversal of drug resistance mediated by drug efflux pumps. These molecules will act as scaffolds for the development of more efficient and effective efflux pump inhibitors that can be used in combination therapy with available antifungals.

Prevalence of pfmdr1 alleles associated with artemether-lumefantrine tolerance/resistance in Maputo before and after the implementation of artemisinin-based combination therapy.

BACKGROUND: Mozambique implemented artemisinin-based combinations therapy (ACT) using artemether-lumefantrine (AL) as the first-line treatment for uncomplicated malaria in 2009. AL remains highly efficacious, but widespread use may soon facilitate emergence of artemisinin tolerance/resistance. The prevalence of pfmdr1 different alleles in Maputo and Mozambique is not known, either after or before the introduction of ACT. Pfmdr1 molecular markers related to Plasmodium falciparum susceptibility were analysed before and after transition to ACT. METHODS: A first group of samples was collected between June 2003 and June 2005 and a second group in the period between March 2010 and March 2012. Three alleles were analysed by PCR-RFLP: N86Y, Y184F and D1246Y, in the pfmdr1 gene. RESULTS: Alleles N86, 184F and D1246 increased from 19.5, 19.6 and 74.4% in 2003-2005 to 73.2, 22.7 and 96.7% in 2010-2012, respectively. After implementation of ACT (2010-2012), pfmdr1 haplotypes, either two- and three-codon basis, were generally less diverse than before the implementation of ACT (2003-2005). The prevalence of haplotypes N86-184Y, N86-D1246 and 184Y-D1246 increased from 12,2, 27.3 and 71.7% in 2003-2005 to 59.4, 84.3 and 78.6% in 2010-2012. The three-codon basis haplotypes NFD and NYD also increased significantly during the same period. CONCLUSION: The alleles N86 and 184 F and the triple haplotype N86-184 F-D1246 showed a significantly increased prevalence after introduction of ACT.

Community health workers: to train or to restrain? A longitudinal survey to assess the impact of training community health workers in the Bolama Region, Guinea-Bissau.

BACKGROUND: The shortage in human resources for health affects most dramatically developing countries which frequently use community health workers (CHW) as the basis for health programmes and services. The traditional definition refers CHWs as members of the community who are recruited and trained in health prevention and promotion to provide services within their community. In Guinea-Bissau, CHWs play a fundamental role in the diagnosis and treatment of childhood diarrheal diseases - one of the main health problems in the country. METHODS: This study is based on 22 CHW, 79% of the total number of CHW in the Sanitary Region of Bolama. The main goal was to assess how training CHW on diarrheal diseases impacted the accuracy of the diagnosis and treatment of these diseases in children under the age of 5 years. Three evaluations were made throughout time - one evaluation before the training and two follow-up evaluations.An observation grid was developed to evaluate the identified signs, symptoms, diagnosis and treatments prescribed by the CHW in consultations to children with a suspicion of diarrhoeal disease. A similar grid was filled by a medical doctor who took the role of the external validation standard.Friedman's variance analysis and Cochran's Q test were performed to compare the accuracy depicted by CHWs in identifying items throughout time. A logistic regression model was also used to check the possible influence of socio-demographic characteristics of CHWs on the accuracy of the diagnosis and treatment prescribed by the CHW. RESULTS: The results show that CHWs improve significantly their performance in identifying the correct diagnosis in the first follow-up moment after the training (P = 0.001, n = 22) but, 3 months later, the effectiveness decreases. No statistical evidence was found for the logistic regression models applied. This progressive loss of performance after training may occur because CHWs fail to apply treatment algorithms and guidelines over time. A limited set of socio-demographic characteristics of the CHWs can influence their performance and should not be disregarded when selecting CHW candidates. CONCLUSION: The selection, supervision, support and continuous training of CHW are as important as the training provided.

Why do some physicians in Portuguese-speaking African countries work exclusively for the private sector? Findings from a mixed-methods study.

BACKGROUND: Despite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector. The present work adopts a mixed-methods approach to explore characteristics, working patterns, choices, and motivations of the physicians working exclusively for the private sector in the capital cities of Cape Verde, Guinea Bissau, and Mozambique. The paper's objective is to contribute to the understanding of such physicians, ultimately informing the policies regulating the medical profession in low- and middle-income countries. METHODS: The qualitative part of the study involved 48 interviews with physicians and health policy-makers and aimed at understanding the practice in the three locations. The quantitative study included a survey of 329 physicians, and multivariate analysis was conducted to analyse characteristics, time allocation, earnings, and motivations of those physicians working only for the private sector, in comparison to their public sector-only and dual practice peers. RESULTS: Our findings showed that only a limited proportion of physicians in the three locations work exclusively for the private sector (11.2%), with members of this group being older than those practicing only in the public or in both sectors. They were found to work fewer hours per week (49 hours) than their public (56 hours) and dual practice peers (62 hours) (P <0.001 and P = 0.011, respectively). Their median earnings were USD 4,405 per month, with substantial variations across the three locations. Statistically significant differences were found with the earnings of public-only physicians (P <0.001), but not with those of the dual practice group (P = 0.340). The qualitative data from the interviews showed private-only physicians' preference for an independent and more flexible work modality, and this was quoted as a determining factor for their choice of sector. This group appears to include those working in the more informal sector, and those who decided to leave the civil service following a disagreement with the public employer. CONCLUSIONS: The study shows the importance of understanding the relation between health professionals' characteristics, motivations, and their engagement with the private sector to develop effective policies to regulate the profession. This may ultimately contribute to achieving universal access to medical services in low- and middle-income countries.

An examination of the association between premature mortality and life expectancy among men in Europe.

BACKGROUND: A feature of the health of men across Europe is their higher rates of premature mortality and shorter life expectancy at birth than women. Following the publication of the first State of Men's Health in Europe report, we sought to explore possible reasons. METHOD: We analyzed trends in life expectancy at birth in 19 European Union member states (EU19) between 1999 and 2008 using mortality data obtained from Eurostat. We then used Pollard's decomposition method to identify the contribution of deaths from different causes and at different age groups to differences in life expectancy. RESULTS: Between 1999 and 2008, life expectancy at birth in the EU19 increased by 2.74 years for men and by 2.09 years for women. Most of these improvements were due to reductions in mortality at ages >60, with cardiovascular disease accounting for approximately half these improvements for men. In 2008, life expectancy of men in the EU19 was 5.92 years lower than that of women. Deaths from all major groups of causes, and at all ages, contributed to this gap, with external causes contributing 0.96 years, cardiovascular disease 1.80 years and neoplasms 1.61 years. CONCLUSION: Improvements in the life expectancy at birth of men and women have mostly occurred at older ages. There has been little improvement in the high rate of premature death in younger men, suggesting a need for interventions to tackle their high death rate.

The aging profile of the Portuguese population: a principal component analysis.

In the last 5 years the resident population of Portugal has increased 2.3%, along with a progressive ageing. This study aims assessing the social dependence and frailty, as well as social and familial support needs of the elderly. In an observational, cross-sectional community based study (EPEPP study), a total of 2,672 people, aged 55 or more, were submitted to an enquiry and several variables were studied among three age groups: 55-64 years old (37%), 65-74 years old (37%) and ≥ 75 years old (26%), encompassing a total of 57% women and 43% men. A questionnaire including items such as physical autonomy, locomotion, falls, health/medical complaints, instrumental autonomy, physical activity, health self-evaluation and emotional status was applied. The strong correlations among the studied scores allowed the identification of people groups with common characteristics when a principal component analysis was used: "autonomy" (scores of instrumental autonomy, locomotion and physical autonomy) and "perception of health and emotional status" (scores of health self-evaluation and emotional status), were present in the three age groups. The component analysis evidences that a good autonomy, a good perception of health and emotional status are determinant to a good quality of life in elderly. Although health status and self-rated health have a propensity to deteriorate with aging, older Portuguese consider their state of health satisfactory and tend to underestimate their decline. In what concerns the analysis of gender with the same age and in contrast to what has been reported, older women alike to men, experience a good mobility and health self-evaluation.

Structured additive regression modeling of age of menarche and menopause in a breast cancer screening program.

Breast cancer risk is believed to be associated with several reproductive factors, such as early menarche and late menopause. This study is based on the registries of the first time a woman enters the screening program, and presents a spatio-temporal analysis of the variables age of menarche and age of menopause along with other reproductive and socioeconomic factors. The database was provided by the Portuguese Cancer League (LPCC), a private nonprofit organization dealing with multiple issues related to oncology of which the Breast Cancer Screening Program is one of its main activities. The registry consists of 259,652 records of women who entered the screening program for the first time between 1990 and 2007 (45-69-year age group). Structured Additive Regression (STAR) models were used to explore spatial and temporal correlations with a wide range of covariates. These models are flexible enough to deal with a variety of complex datasets, allowing us to reveal possible relationships among the variables considered in this study. The analysis shows that early menarche occurs in younger women and in municipalities located in the interior of central Portugal. Women living in inland municipalities register later ages for menopause, and those born in central Portugal after 1933 show a decreasing trend in the age of menopause. Younger ages of menarche and late menopause are observed in municipalities with a higher purchasing power index. The analysis performed in this study portrays the time evolution of the age of menarche and age of menopause and their spatial characterization, adding to the identification of factors that could be of the utmost importance in future breast cancer incidence research.