Trajectories and determinants of ageing in Portugal: insights from EpiDoC, a nationwide population-based cohort.

INTRODUCTION: The population in Portugal is ageing due to increased life expectancy and reduced fertility rates. We aimed to estimate the health trajectories of Portuguese older adults (60 + years old) in a 10-year period and to assess associated sociodemographic, lifestyle factors and multimorbidity status. METHODS: Using the population-based EpiDoC cohort, we estimated the trajectories of health-related quality of life and physical function of 4135 Portuguese older adults over 10 years using linear mixed models. Factors associated to health-related quality of life and physical function were assessed using linear mixed models and random intercept tobit regression, respectively. RESULTS: The physical disability of participants increased by 0.263 (0.240, 0.286), and health-related quality of life declined by 0.074 (-0.084, -0.063), over 10 years. With advancing age, older adults reported a faster reduction in health-related quality of life and faster increase in physical disability. In general, women were in worse health than men at baseline, albeit with a similar rate of change throughout the follow-up. Higher education and regular exercise were associated with better health-related quality of life and physical function while multimorbidity and excess weight were associated with worse reporting of these outcomes. CONCLUSIONS: These findings, based on longitudinal data with 10 years of follow-up, are essential to effectively plan resource allocation, plan better healthcare and design informed public health policies in Portugal. This study characterizes ageing in Portugal showing increased physical disability and decreased health-related quality of life with advancing age older adults, helping to develop public health policies.

Trajectories of physical function and quality of life in people with osteoarthritis: results from a 10-year population-based cohort.

OBJECTIVE: To identify long-term trajectories of physical function and health-related quality of life (HRQoL) among people with hip and/or knee osteoarthritis (HKOA) and the sociodemographic, lifestyle, and clinical factors associated with different trajectories. METHODS: Participants with HKOA from the EpiDoC study, a 10-year follow-up (2011-2021) population-based cohort, were considered. Sociodemographic, lifestyle, and clinical variables were collected at baseline in a structured interview and clinical appointment. Physical function and HRQoL were evaluated with the Health Assessment Questionnaire (HAQ) and EuroQoL, respectively, at baseline and the three follow-ups. Group-based trajectory modeling identified physical function and HRQoL trajectories. Multinomial logistic regression analyzed the associations between the covariates of interest and trajectory assignment (p < 0.05). RESULTS: We included 983 participants with HKOA. We identified three trajectories for each outcome: "consistently low disability" (32.0%), "slightly worsening moderate disability" (47.0%), and "consistently high disability" (21.0%) for physical function; "consistently high HRQoL" (18.3%), "consistently moderate HRQoL" (48.4%) and "consistently low HRQoL" (33.4%) for HRQoL. Age ≥ 75 years, female sex, multimorbidity, and high baseline clinical severity were associated with higher risk of assignment to poorer physical function and HRQoL trajectories. Participants with high education level and with regular physical activity had a lower risk of assignment to a poor trajectory. Unmanageable pain levels increased the risk of assignment to the "consistently moderate HRQoL" trajectory. CONCLUSION: Although the trajectories of physical function and HRQoL remained stable over 10 years, approximately 70% of people with HKOA maintained moderate or low physical function and HRQoL over this period. Modifiable risk factors like physical activity, multimorbidity and clinical severity were associated with poorer physical function and HRQoL trajectories. These risk factors may be considered in tailored healthcare interventions.

Prevalence of and factors associated with unmanageable pain levels in people with knee or hip osteoarthritis: a cross-sectional population-based study.

BACKGROUND: Pain due to knee and / or hip osteoarthritis (HKOA) is the most common symptom for seeking healthcare. Pain interferes on daily activities, social and occupational participation in people with HKOA. The goal of this study is to estimate the prevalence of unmanageable pain levels (UPL) among people with HKOA), characterize this population and identify factors associated with UPL, and compare therapeutic strategies used by people with UPL versus manageable pain levels (MPL). METHODS: We analysed data from the EpiReumaPt study (n = 10,661), that included a representative sample of the Portuguese population. Among these, 1081 participants had a validated diagnosis of HKOA by a rheumatologist.. Sociodemographic, lifestyle and health-related data were collected in a structured interview. Pain intensity (NPRS) data were collected in a medical appointment. Painmedication (last month), physiotherapy and surgery were considered as therapies for pain management. UPL was defined as a mean pain intensity in the previous week of ≥5 points on 11-point numeric pain rating scale. The factors associated with UPL were analyzed with logistic regression (p < 0.05, 95%CI). The effect of unmanageable pain levels was assessed by the HOOS/KOOS activities of daily living and quality of life subscales. Symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Analysis was completed with linear and logistic regression. All analysis were weighted. RESULTS: The estimated prevalence of UPL among people with HKOA was 68.8%. UPL was associated with being female (odds ratio (OR) = 2.36, p < 0.001), being overweight (OR = 1.84, p = 0.035) or obese (OR = 2.26, p = 0.006), and having multimorbidity (OR = 2.08, p = 0.002). People with UPL reported worse performance in activities of daily living and lower quality of life (ß = - 21.28, p < 0.001 and ß = - 21.19, p < 0.001, respectively) than people with MPL. People with UPL consumed more NSAIDs (22.0%, p = 0.003), opioids (4.8%, p = 0.008), paracetamol (2.7%, p = 0.033), and overall analgesics (7.3%, p = 0.013) than people with MPL. A higher proportion of people with UPL underwent physiotherapy (17.5%, p = 0.002) than people with MPL. CONCLUSION: Two-thirds of people with HKOA in Portugal have poor management of their pain levels. Clinical and lifestyle factors, that are highly presented in individuals with HKOA, are associated with unmanageable pain. Our results highlighting the need for further research and implementation of effective interventions to improve pain, function and quality of life in people with HKOA.

Large hemorrhagic stroke after ChAdOx1 nCoV-19 vaccination: A case report.

BACKGROUND: The anti-COVID-19 vaccines are new, and we should be alert of potential adverse effects of them. AIMS OF THE STUDY: To report a case of a large hemorrhagic stroke 5 days after ChAdOx1 nCoV-19 vaccination. METHODS: Clinical, imaging, and laboratory data of a patient with stroke admitted to our emergency department. RESULTS: A woman, 57 years old, took the first dose of the ChAdOx1 nCoV-19 vaccine and shortly thereafter presented mild systemic symptoms and started on aspirin. On day 5, she had a sudden onset of sweating and paleness, which has followed by left hemiparesis, vomiting, and somnolence. Computed tomography showed a large right deep frontal lobe parenchymal hematoma with the inundation of the entire ventricular system. Platelets count, fibrinogen, prothrombin time, and D-dimer were normal. Digital subtraction angiography did not show any signs of thrombosis or aneurysms in brain circulation. CONCLUSIONS: Clinicians should be aware of cerebrovascular adverse effects of ChAdOx1 nCoV-19, including out-of-context of vaccine-induced immune thrombotic thrombocytopenia.

COVID-19 mRNA vaccine and antibody response in lactating women: a prospective cohort study.

BACKGROUND: Immunological protection via breastfeeding is well known. The immunological profile of human milk changes during lactation. No clinical trials have been conducted in lactating women with the newest mRNA vaccines against SARS- CoV-2. A Few studies have shown the presence of antibodies in breastmilk after vaccination. The aim of this work is to study possible antibodies transfer via breastmilk and also the immunological characteristics of lactating women compared to non-lactating women, after using the BNT162b2 Pfizer vaccine. METHODS: This is a prospective cohort study with a convenience homogenous sample of 24 healthcare workers (14 lactating and 10 non-lactating women) enrolled at the time of COVID-19 vaccination. Clinical data was registered in a questionnaire. Titers of SARS-CoV-2 spike IgG, IgA and IgM were quantified in post vaccination blood and human milk. Antibody quantification was performed by an in-house ELISA to SARS-CoV-2 trimeric spike protein. RESULTS: All women showed immunity after vaccination with positive antibodies for IgM, IgA and IgG antibodies. The dominant serum antibody response was IgG. Modest levels of antibodies in breastmilk of lactating mothers were observed in this study, especially IgG in 42.9%. There was a moderate association between higher titers of IgG and a longer duration of breastfeeding (R= 0.55, p=0.041). CONCLUSIONS: Evidence of antibody transfer in human milk after COVID-19 vaccination is scarce. The presence of antibodies in human milk is reported, but immunization through breastfeeding is still to be established.

Estimation of suspended sediment concentration in Guamá River in the Amazon region.

Monitoring of the suspended sediment concentration (SSC) is important for the analysis of morphological processes in watersheds and rivers, river habitats, and human activities associated with river management. Acoustic Doppler current profilers (ADCP) are used for measurements of flow and velocity in rivers through acoustic waves, which can also be converted into sediment concentrations. In this context, the objective is to verify the applicability of the use of ADCPs (Sontek YSI, model M9 River Surveyor) as an alternative for SSC estimates, this being a recent application of the equipment, mainly in rivers in the Amazon region rich in sediments in suspension. Thus, the Gartner method was used, calibrating its equation with the concentrations obtained by the point sampling method, collected with a bottle of Van Dorn in the Guamá River, Amazon, Brazil. The method used to obtain the SSC with data measured via ADCP resulted in a satisfactory estimate of the concentrations. The correlations between the measured and estimated sediment concentrations had R2 = 0.6827 for point sampling method and R2 = 0.8103 for vertically averaged SSC. These satisfactory results demonstrate the potential of using ADCP to estimate sediments suspended in Amazon basin.

Amine Modification of Silica Aerogels/Xerogels for Removal of Relevant Environmental Pollutants.

Serious environmental and health problems arise from the everyday release of industrial wastewater effluents. A wide range of pollutants, such as volatile organic compounds, heavy metals or textile dyes, may be efficiently removed by silica materials advanced solutions such as aerogels. This option is related to their exceptional characteristics that favors the adsorption of different contaminants. The aerogels performance can be selectively tuned by an appropriate chemical or physical modification of the aerogel's surface. Therefore, the introduction of amine groups enhances the affinity between different organic and inorganic contaminants and the silica aerogels. In this work, different case studies are reported to investigate and better understand the role of these functional groups in the adsorption process, since the properties of the synthesized aerogels were significantly affected, regarding their microstructure and surface area. In general, an improvement of the removal efficiency after functionalization of aerogels with amine groups was found, with removal efficiencies higher than 90% for lead and Rubi Levafix CA. To explain the adsorption mechanism, both Langmuir and Freundlich models were applied; chemisorption is most likely the sorption type taking place in the studied cases.

Binding of phenothiazines into allosteric hydrophobic pocket of human thioredoxin 1.

Thioredoxins are multifunctional oxidoreductase proteins implicated in the antioxidant cellular apparatus and oxidative stress. They are involved in several pathologies and are promising anticancer targets. Identification of noncatalytic binding sites is of great interest for designing new allosteric inhibitors of thioredoxin. In a recent work, we predicted normal mode motions of human thioredoxin 1 and identified two major putative hydrophobic binding sites. In this work we investigated noncovalent interactions of human thioredoxin 1 with three phenotiazinic drugs acting as prooxidant compounds by using molecular docking and circular dichroism spectrometry to probe ligand binding into the previously predicted allosteric hydrophobic pockets. Our in silico and CD spectrometry experiments suggested one preferred allosteric binding site involving helix 3 and adopting the best druggable conformation identified by NMA. The CD spectra showed binding of thioridazine into thioredoxin 1 and suggested partial helix unfolding, which most probably concerns helix 3. Taken together, these data support the strategy to design thioredoxin inhibitors targeting a druggable allosteric binding site.

Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study.

BACKGROUND: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. OBJECTIVE: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. METHODS: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. RESULTS: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). CONCLUSIONS: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/29675.

Challenges and opportunities for sarcoma care and research in Latin America: a position paper from the LACOG sarcoma group.

As a developing region, Latin America faces unique cancer control and prevention challenges, which are intensified when considering rare cancers, including sarcomas. Sarcomas are a group of malignancies that arise in the connective tissues of the body-such as muscle, fat, nerves, blood vessels, and bones-accounting for a diverse range of tumours that, although rare, require specialized attention. Sarcoma care and research in Latin America require a comprehensive approach that includes deeper epidemiologic knowledge, diagnostic capacity building, access to innovative treatments, increased patient advocacy, and strengthening of clinical research capacity. This article will review current challenges and opportunities for treating patients with sarcoma in Latin America and outline a pathway toward improvement for regional collaborative groups.

Validating the dental subscale of the children's fear survey schedule using Rasch analysis.

Rasch analysis was used to examine the validity of the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS). Data were collected from parents of children in regular dental care (n = 240) and from parents of children referred to a specialized pediatric dental clinic (n = 200). The Rasch model is a probabilistic model in which estimations are based on the relationship between person ability and item difficulty, and the present study investigated the validity of the CFSS-DS through analysis of person and item fit, dimensionality, ordering of thresholds, local dependency, and differential item functioning. The results show multidimensionality of the original scale, and an adjusted version consisting of six items with good fit to the model is suggested. The adjusted scale makes interval-level analysis possible, and time efficiency and elimination of previously criticized items argue in favor of the adjusted scale.

Carbon Nanostructures-Silica Aerogel Composites for Adsorption of Organic Pollutants.

Silica aerogels are a class of materials that can be tailored in terms of their final properties and surface chemistry. They can be synthesized with specific features to be used as adsorbents, resulting in improved performance for wastewater pollutants' removal. The purpose of this research was to investigate the effect of amino functionalization and the addition of carbon nanostructures to silica aerogels made from methyltrimethoxysilane (MTMS) on their removal capacities for various contaminants in aqueous solutions. The MTMS-based aerogels successfully removed various organic compounds and drugs, achieving adsorption capacities of 170 mg⋅g-1 for toluene and 200 mg⋅g-1 for xylene. For initial concentrations up to 50 mg⋅L-1, removals greater than 71% were obtained for amoxicillin, and superior to 96% for naproxen. The addition of a co-precursor containing amine groups and/or carbon nanomaterials was proven to be a valuable tool in the development of new adsorbents by altering the aerogels' properties and enhancing their adsorption capacities. Therefore, this work demonstrates the potential of these materials as an alternative to industrial sorbents due to their high and fast removal efficiency, less than 60 min for the organic compounds, towards different types of pollutants.

Corrigendum to "Multimorbidity is associated with fragility fractures in women 50 years and older: A nationwide cross-sectional study" [Bone Rep. 15 (2021) 101139 (December)].

[This corrects the article DOI: 10.1016/j.bonr.2021.101139.].

Flowering Coriander (Coriandrum sativum) Strips Do Not Enhance Ecosystem Services in Azorean Orchards.

The effect of flower strips on ecosystem services (ESs) and disservices (EDs) is routinely assessed following changes in service provider densities without measuring the associated levels of ES/EDs. By using the sentinel approach (i.e., exposing a plant, seeds, and prey models in a standardized way), we tested how coriander (Coriandrum sativum) strips planted in mixed orchards on Terceira Island (Azores, Portugal) affected herbivory on lettuce plants, seed predation on wheat and weed seeds, and predation on artificial caterpillars. Vertebrates had more influence than invertebrates on ESs/EDs. Herbivory (ED) after 2 weeks was similar in the coriander and the control plots (mean ± SD; 2.3% ± 3.3% vs. 2.2% ± 2.9%, n = 32 for both). Seed predation was higher in the control than in the coriander plots for both grain (ED; 30.8% ± 38.9% vs. 15.3% ± 10.8%, n = 18 for both) and weed seeds (ES; 2.5% ± 4.1% vs. 0.4% ± 0.5%, n = 18 for both). Vertebrate predation (ES) rates after 48 h were significantly higher in the control (estimate 9%, 95% CI: 4-20%) than in the coriander plots (3%, 1-8%), while no difference was observed for invertebrate predation. Coriander strips did not support increased ES/reduced ED levels in this setting. The tools used can be effective to quantitatively compare multiple ESs/EDs under different farming management strategies.

Dietary Exposure to Toxic Metals (Cd, Pb and Hg) from Cereals Marketed in Madeira and the Azores.

Cereals and cereal-based foods continue to be basic foods in all diets. Despite being known for their high nutritional value; they can also contain contaminants (hazards) such as toxic metals. This study assesses the Cd, Pb and Hg dietary exposure from cereals and derivatives marketed in Madeira and the Azores and characterizes the risks by evaluating the Cd and Hg intake contributions to the tolerable intakes and by estimating the Margin of Exposure (MOE) in the case of Pb. In Madeira, metals follow the descending order of Cd > Pb > Hg. Cd stands out as having the highest levels (0.307 mg Cd/kg in oats; 0.237 mg/kg in rye). High levels of Pb (0.347 mg/kg) were also detected in rye. Regarding total mercury, rice stands out (0.0013 mg/kg) followed by wheat (0.001 mg/kg). While all cereals and derivatives except maize consumed in Madeira exceed the maximum value of Cd allowed by the EU, 50.0% of the rye and 25.0% of the corn flour samples exceeded the European Pb limit. The daily consumption of 100 g of oats, rye flour and rye represent high contributions to the TWI of Cd (93.2 - 120%). The MOE values of Pb from the consumption of rye (100 g/day) are 1,294 (nephrotoxic effects) and 3,082 (cardiotoxic effects). In the Azores, corn flour (0.72 mg Pb/kg) stands out with 85.7% of the samples exceeding the maximum Pb EU limit and MOE values of 626 (nephrotoxic effects) and 1,490 (cardiotoxic effects). Regular daily consumption of corn flour makes a low (< 10%) contribution to the Cd TDI. In conclusion, the Pb exposure from the consumption of cereals and derivatives could have toxic effects such as nephrotoxicity or cardiotoxicity in adults. The results highlight the need to set up monitoring and surveillance programs for the safety of cereals and their derivatives in Madeira and the Azores in terms of lead and cadmium.

Association of physical activity with physical function and quality of life in people with hip and knee osteoarthritis: longitudinal analysis of a population-based cohort.

Hip and knee osteoarthritis (HKOA) is a chronic disease characterized by joint pain that leads to reduced physical function and health-related quality of life (HRQoL). At present, no cure is available. Clinical trials indicate that people with HKOA benefit from physical activity in several health-related outcomes. However, few studies have evaluated the long-term positive effect of regular physical activity. This study analyzed participants with HKOA from a nationwide population-based cohort (EpiDoC Cohort) to assess the impact of physical activity on patients' physical function and HRQoL over a long-term follow-up. The regular weekly frequency of intentional physical activity was self-reported as non-frequent (0 times/week), frequent (1-2 times/week), or very frequent (≥ 3 times/week). This study followed 1086 participants over a mean period of 4.7 ± 3.4 years, during which 6.3% and 14.9% of participants reported frequent and very frequent physical activity, respectively. Using linear mixed models, we found that frequent (ß = - 0.101 [- 0.187, - 0.016]; ß = 0.039 [- 0.002, 0.080]) and very frequent physical activity (ß = - 0.061 [- 0.118, - 0.004]; ß = 0.057 [0.029, 0.084]) were associated with improved physical function and HRQoL over time, respectively, when compared with non-frequent exercise, adjusting for years to baseline, sex, age, years of education, body mass index, multimorbidity, hospitalizations, clinical severity, and unmanageable pain levels. These findings raise awareness of the importance of maintaining exercise/physical activity long term to optimize HRQoL and physical function. Further studies must address barriers and facilitators to improve the adoption of regular physical activity among citizens with HKOA.

Monitoring ten insect pests in selected orchards in three Azorean Islands: The project CUARENTAGRI.

Background: The data we present are part of the CUARENTAGRI project, which involves all archipelagos of the Macaronesia (Azores, Madeira, Canary Islands and Cabo Verde). The project aims to: i) identify and evaluate the risks associated with the introduction of new arthropod pests; ii) study the population dynamics of selected arthropod pest species currently responsible for the damage of key target crops and iii) develop monitoring systems, based on prediction and/or population dynamics of the crop pests, creating warnings and a phytosanitary prevention system. In this contribution, we compile data for three Azorean Islands (Terceira, São Jorge and São Miguel Islands), where pheromone-baited traps were placed in pastures, potato fields and several orchards' types (apples, banana, chestnuts, olives, orange and strawberry), during three consecutive years (2020, 2021 and 2022). New information: A total of 114,827 specimens of insects (Arthropoda, Insecta) were collected, belonging to four orders, six families and ten recorded pest species. A total of eight species are considered introduced (Cosmopolitessordidus (Germar, 1824), Drosophilasuzukii (Matsumura, 1931), Bactroceraoleae (Rossi, 1790), Ceratitiscapitata (Wiedemann, 1824), Phthorimaeaoperculella (Zeller, 1873), Cydiapomonella (Linnaeus, 1758), Cydiasplendana (Hübner, 1799) and Grapholitamolesta (Busck, 1916); n = 84,986 specimens) and two native non-endemic (Mythimnaunipuncta (Haworth, 1809) and Spodopteralittoralis (Boisduval, 1833); n = 17,465 specimens). This study intended to contribute to a better knowledge of the arthropods pests that can affect the Azorean crops and will serve as a baseline for future monitoring actions, pest risk assessments and prevention systems.

Cost Evaluation Analysis of Genetic Testing and Tailored Adjuvant Imatinib in Patients With Resected High-Risk GI Stromal Tumors: The Brazilian Perspective.

PURPOSE: Mutations of the KIT gene are the molecular hallmark of most GI stromal tumors (GISTs). Imatinib has revolutionized GIST treatment. Adjuvant imatinib for 3 years is the standard of care for high-risk resected GIST. However, the GIST molecular biologic profile has found different responses to this approach. Despite this, genetic testing at diagnosis is not a routine and empirical adjuvant imatinib remains the rule. Barriers to genetic profiling include concerns about the cost and utility of testing. This analysis aims to determine whether targeted genetic testing reduces costs as an ancillary tool for a limited-resource scenario instead of adjuvant empirical imatinib in patients with resected high-risk GIST. METHODS: The cost evaluation analysis of molecular testing for GIST was based on the Cost of Preventing an Event (COPE), considering the Number Needed to Treat and the costs of each test compared with the cost of 3-year empirical adjuvant imatinib and real treatment costs (median number of cycles) from the public and private Brazilian Healthcare System's perspective. The analysis compared the costs of the molecular tests (broad next-generation sequencing [NGS], GS Infinity DNA/RNA assay, and targeted NGS: GS Focus GIST and the Fleury GIST Tumor DNA sequencing panel), costs of drug acquisition, considering discounts (imatinib mesylate and Glivec), and the costs of supportive care. RESULTS: In both scenarios, public and private, regardless of the use of imatinib or Glivec, tailoring adjuvant treatment reduced costs, irrespective of the number of cycles. The only exception was the combination of the broad NGS test and imatinib in the Public Healthcare System. CONCLUSION: The molecularly tailored adjuvant imatinib reduced costs considering the COPE of available NGS tests for both the public and private Brazilian health care systems.