Advancing air quality monitoring: A low-cost sensor network in motion - Part I.

In urban areas, high levels of air pollution pose significant risks to human health, emphasising the need for detailed air quality (AQ) monitoring. However, traditional AQ monitoring relies on the data from Reference Monitoring Stations, which are sparsely distributed and provide only hourly or daily data, failing to capture the spatial and temporal variability of air pollutant concentrations. Addressing this challenge, we introduce in this article the ExpoLIS system, an all-weather mobile AQ monitoring system that integrates various AQ low-cost sensors (LCSs), providing high spatio-temporal resolution data. This study demonstrates that the inclusion of an extended sampling device may mitigate the effect of the meteorological parameters and other disturbances on readings. At the same time, it did not reduce the quality of the data, both in static conditions and in motion, as we were able to maintain a certain level of agreement between the LCSs. In conclusion, the ExpoLIS system proves its versatility by enabling the collection of large quantities of accurate data, allowing a deeper understanding of the AQ dynamics in urban environments.

Chemical characterisation of particulate matter in urban transport modes.

Traffic is a main source of air pollutants in urban areas and consequently daily peak exposures tend to occur during commuting. Personal exposure to particulate matter (PM) was monitored while cycling and travelling by bus, car and metro along an assigned route in Lisbon (Portugal), focusing on PM2.5 and PM10 (PM with aerodynamic diameter <2.5 and 10 µm, respectively) mass concentrations and their chemical composition. In vehicles, the indoor-outdoor interplay was also evaluated. The PM2.5 mean concentrations were 28 ± 5, 31 ± 9, 34 ± 9 and 38 ± 21 µg/m3 for bus, bicycle, car and metro modes, respectively. Black carbon concentrations when travelling by car were 1.4 to 2.0 times higher than in the other transport modes due to the closer proximity to exhaust emissions. There are marked differences in PM chemical composition depending on transport mode. In particular, Fe was the most abundant component of metro PM, derived from abrasion of rail-wheel-brake interfaces. Enhanced concentrations of Zn and Cu in cars and buses were related with brake and tyre wear particles, which can penetrate into the vehicles. In the motorised transport modes, Fe, Zn, Cu, Ni and K were correlated, evidencing their common traffic-related source. On average, the highest inhaled dose of PM2.5 was observed while cycling (55 µg), and the lowest in car travels (17 µg). Cyclists inhaled higher doses of PM2.5 due to both higher inhalation rates and longer journey times, with a clear enrichment in mineral elements. The presented results evidence the importance of considering the transport mode in exposure assessment studies.

Relationship between indoor and outdoor size-fractionated particulate matter in urban microenvironments: Levels, chemical composition and sources.

Exposure to particulate matter (PM) has been associated with adverse health outcomes, particularly in susceptible population groups such as children. This study aims to characterise children's exposure to PM and its chemical constituents. Size-segregated aerosol samples (PM0.25, PM0.25-0.5, PM0.5-1.0, PM1.0-2.5 and PM2.5-10) were collected in the indoor and outdoor of homes and schools located in Lisbon (Portugal). Organic and elemental carbon (OC and EC) were determined by a thermo-optical method, whereas major and trace elements were analysed by X-Ray Fluorescence. In school, the children were exposed to higher PM concentrations than in home, which might be associated not only to the elevated human occupancy but also to outdoor infiltration. The pattern of PM mass size distribution was dependent on the location (home vs. school and indoor vs. outdoor). The presence of EC in PM0.25 and OC in PM0.25-0.5 was linked to traffic exhaust emissions. OC and EC in PM2.5-10 may be explained by their adhesion to the surface of coarser particles. Generally, the concentrations of mineral and marine elements increased with increasing PM size, while for anthropogenic elements happened the opposite. In schools, the concentrations of mineral matter, anthropogenic elements and marine aerosol were higher than in homes. High mineral matter concentrations found in schools were related to the close proximity to busy roads and elevated human occupancy. Overall, the results suggest that exposure to PM is relevant and highlights the need for strategies that provide healthier indoor environments, principally in schools.

Factors controlling air quality in different European subway systems.

Sampling campaigns using the same equipment and methodology were conducted to assess and compare the air quality at three South European subway systems (Barcelona, Athens and Oporto), focusing on concentrations and chemical composition of PM2.5 on subway platforms, as well as PM2.5 concentrations inside trains. Experimental results showed that the mean PM2.5 concentrations widely varied among the European subway systems, and even among different platforms within the same underground system, which might be associated to distinct station and tunnel designs and ventilation systems. In all cases PM2.5 concentrations on the platforms were higher than those in the urban ambient air, evidencing that there is generation of PM2.5 associated with the subway systems operation. Subway PM2.5 consisted of elemental iron, total carbon, crustal matter, secondary inorganic compounds, insoluble sulphate, halite and trace elements. Of all metals, Fe was the most abundant, accounting for 29-43% of the total PM2.5 mass (41-61% if Fe2O3 is considered), indicating the existence of an Fe source in the subway system, which could have its origin in mechanical friction and wear processes between rails, wheels and brakes. The trace elements with the highest enrichment in the subway PM2.5 were Ba, Cu, Mn, Zn, Cr, Sb, Sr, Ni, Sn, Co, Zr and Mo. Similar PM2.5 diurnal trends were observed on platforms from different subway systems, with higher concentrations during subway operating hours than during the transport service interruption, and lower levels on weekends than on weekdays. PM2.5 concentrations depended largely on the operation and frequency of the trains and the ventilation system, and were lower inside the trains, when air conditioning system was operating properly, than on the platforms. However, the PM2.5 concentrations increased considerably when the train windows were open. The PM2.5 levels inside the trains decreased with the trains passage in aboveground sections.

Urban air quality comparison for bus, tram, subway and pedestrian commutes in Barcelona.

Access to detailed comparisons in air quality variations encountered when commuting through a city offers the urban traveller more informed choice on how to minimise personal exposure to inhalable pollutants. In this study we report on an experiment designed to compare atmospheric contaminants inhaled during bus, subway train, tram and walking journeys through the city of Barcelona. Average number concentrations of particles 10-300 nm in size, N, are lowest in the commute using subway trains (N<2.5×10(4) part. cm(-3)), higher during tram travel and suburban walking (2.5×10(4) cm(-3)5.0×10(4) cm(-3)), with extreme transient peaks at busy traffic crossings commonly exceeding 1.0×10(5) cm(-3) and accompanied by peaks in Black Carbon and CO. Subway particles are coarser (mode 90 nm) than in buses, trams or outdoors (<70 nm), and concentrations of fine particulate matter (PM2.5) and Black Carbon are lower in the tram when compared to both bus and subway. CO2 levels in public transport reflect passenger numbers, more than tripling from outdoor levels to >1200 ppm in crowded buses and trains. There are also striking differences in inhalable particle chemistry depending on the route chosen, ranging from aluminosiliceous at roadsides and near pavement works, ferruginous with enhanced Mn, Co, Zn, Sr and Ba in the subway environment, and higher levels of Sb and Cu inside the bus. We graphically display such chemical variations using a ternary diagram to emphasise how "air quality" in the city involves a consideration of both physical and chemical parameters, and is not simply a question of measuring particle number or mass.

Motor stereotypies in autism spectrum disorder: Clinical randomized study and classification proposal.

LAY ABSTRACT: Motor stereotypies are one of the most frequent features in children with a diagnosis of autism spectrum disorder. They may disrupt children's functioning and development and be a potential source of stress for families. Several factors, including sex, age, cognitive ability, and severity of autism spectrum disorder, may influence the presence and intensity of stereotypies. The present study aimed to identify the prevalence of motor stereotypies in a group of children with autism spectrum disorder. In addition, it sought to investigate whether sex, age, cognitive ability, verbal language, neurological comorbidities, and severity of autism spectrum disorder were associated with an increased probability and higher number, duration, and variability of stereotypies. A total of 134 participants aged 2.3-17.6 years underwent a clinical protocol with standardized video-recorded sessions. Stereotypies were identified and classified by two independent evaluators. The prevalence of stereotypies was 56.7%, and a total of 1198 motor stereotypies were captured. Children who were younger, nonverbal, and had higher severity of autism spectrum disorder had an increased probability of presenting stereotypies. Being nonverbal or having higher severity of autism spectrum disorder was also associated with presenting a higher number of stereotypies. Children with developmental delay, intellectual disability, or epilepsy displayed longer stereotypies, and children with developmental delay or intellectual disability additionally presented more diverse stereotypies. As part of the study, the authors present a clinical classification model, a glossary, and video samples of motor stereotypies. The findings of this study suggest that children who are younger, nonverbal, have lower cognitive ability, and have higher severity of autism spectrum disorder may have a higher burden of stereotypies. Earlier intervention and monitoring of these children have the potential to improve their long-term outcomes.

A Low-Cost Sensor System Installed in Buses to Monitor Air Quality in Cities.

Air pollution is an important source of morbidity and mortality. It is essential to understand to what levels of air pollution citizens are exposed, especially in urban areas. Low-cost sensors are an easy-to-use option to obtain real-time air quality (AQ) data, provided that they go through specific quality control procedures. This paper evaluates the reliability of the ExpoLIS system. This system is composed of sensor nodes installed in buses, and a Health Optimal Routing Service App to inform the commuters about their exposure, dose, and the transport's emissions. A sensor node, including a particulate matter (PM) sensor (Alphasense OPC-N3), was evaluated in laboratory conditions and at an AQ monitoring station. In laboratory conditions (approximately constant temperature and humidity conditions), the PM sensor obtained excellent correlations (R2≈1) against the reference equipment. At the monitoring station, the OPC-N3 showed considerable data dispersion. After several corrections based on the k-Köhler theory and Multiple Regression Analysis, the deviation was reduced and the correlation with the reference improved. Finally, the ExpoLIS system was installed, leading to the production of AQ maps with high spatial and temporal resolution, and to the demonstration of the Health Optimal Routing Service App as a valuable tool.

Source apportionment of children daily exposure to particulate matter.

The present study aims to investigate the sources of particulate pollution in indoor and outdoor environments, with focus on determining their contribution to the exposure of children to airborne particulate matter (PM). To this end, parallel indoor and outdoor measurements were carried out for a selection of 40 homes and 5 schools between September 2017 and October 2018. PM2.5 and PM2.5-10 samples were collected during five days in each microenvironment (ME) and analysed by X-Ray Fluorescence (XRF), for the determination of elements, and by a thermal-optical technique, for the measurement of organic and elemental carbon. The source apportionment analysis of the PM composition data, by means of the receptor model SoFi (Source Finder) 8 Pro, resulted in the identification of nine sources: exhaust and non-exhaust emissions from traffic, secondary particles, heavy oil combustion, industry, sea salt, soil, city dust, and an indoor source characterized by high levels of organic carbon. Integrated daily exposure to PM2.5 was on average 21 µg/m3. The organic matter, resulting from cleaning, cooking, smoking and biological material, was the major source contributing by 31% to the PM2.5 exposure. The source city dust, which was highly influenced by the resuspension of dust in classrooms, was the second main source (26%), followed by traffic (24%). The major sources affecting the integrated exposure to PM10, which was on average 33 µg/m3, were the city dust (39%), indoor organics (24%) and traffic (16%). This study provides important information for the design of measures to reduce the exposure of children to PM.

HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus.

Objective: Evaluate the celiac disease (CD) markers, within the scope of its screening, in a pediatric population with diagnosis of type 1 diabetes (T1D) at Hospital de Braga (HB) and determine the prevalence of CD in the sample. Reflect on CD screening algorithm applied in this pediatric population. Methods: Retrospective observational study with 94 patients diagnosed with T1D at age 10 years or younger, followed up at the HB Outpatient Diabetology Consultation, including those referred from other hospitals. Record of clinical information, IgA anti-transglutaminase and anti-endomysium and HLA DQ2/DQ8 haplotypes. Results: We obtained positive serological test for CD in 4 patients. This test had 100% sensitivity and specificity. The prevalence of CD was 4.3% (n = 4). Positive HLA screening in 84.6% of patients, with both sensitivity and negative predictive value of 100% and specificity of 16.67%. Diagnosis of CD was made on average 3.40 ± 3.32 years after the diagnosis of TD1. All cases of CD registered non-gastrointestinal manifestations, none had gastrointestinal symptoms. Conclusion: This study proved that there is a higher prevalence of CD in pediatric population with TD1, when compared to general population, and clarified the importance of CD screening. Furthermore, it was observed that serological screening for CD antibodies is an excellent screening test and HLA typing, although not the most suitable first line test, can be useful in excluding the possibility of patients with T1D developing CD.

Screening a Targeted Panel of Genes by Next-Generation Sequencing Improves Risk Stratification in Real World Patients with Acute Myeloid Leukemia.

Although mutation profiling of defined genes is recommended for classification of acute myeloid leukemia (AML) patients, screening of targeted gene panels using next-generation sequencing (NGS) is not always routinely used as standard of care. The objective of this study was to prospectively assess whether extended molecular monitoring using NGS adds clinical value for risk assessment in real-world AML patients. We analyzed a cohort of 268 newly diagnosed AML patients. We compared the prognostic stratification of our study population according to the European LeukemiaNet recommendations, before and after the incorporation of the extended mutational profile information obtained by NGS. Without access to NGS data, 63 patients (23%) failed to be stratified into risk groups. After NGS data, only 27 patients (10%) failed risk stratification. Another 33 patients were re-classified as adverse-risk patients once the NGS data was incorporated. In total, access to NGS data refined risk assessment for 62 patients (23%). We further compared clinical outcomes with prognostic stratification, and observed unexpected outcomes associated with FLT3 mutations. In conclusion, this study demonstrates the prognostic utility of screening AML patients for multiple gene mutations by NGS and underscores the need for further studies to refine the current risk classification criteria.

Adolescer Saudável: screening and follow-up of risk at school.

OBJECTIVE: To characterize adolescents referred to medical consultation based on the screening tool "Perfil de Saúde do Utente Adolescente", and to compare to information gathered from a questionnaire and data assessed during the visit. METHODS: A retrospective and descriptive study, with analysis of the questionnaires filled out by adolescents and their respective medical records, in the period from January 2013 to June 2016. RESULTS: A total of 54 adolescents were seen, 57% male and mean age of 12±1.7 years. In the questionnaire, 37% stated that they had some kind of health problem; 35% would like to change the relationship with their parents; 18% had some concern about safety at school; and 39% made dietary mistakes. Approximately 31% had consumed alcohol, 13% had tried smoking, and 4% had used other drugs. At the first medical appointment, 38% stated they had chronic disease, 11% reported poor family environment, 39% had school problems and 39% made dietary mistakes. About 13% had tried smoking, 24% had tried to consume alcohol, and 2% had tried other drugs. Thirty seven percent of adolescents were referred to adolescent medicine consultation, and 39% to another hospital consultation. CONCLUSION: Many of the biopsychosocial risk items identified through the questionnaire were confirmed during consultation, indicating that it could be a useful screening method for problems linked to the adolescence period.

Lung-deposited dose of particulate matter from residential exposure to smoke from wood burning.

Residential settings are of utmost importance for human exposure, as it is where people spend most of their time. Residential wood combustion is a widespread practice known as a source of indoor particulate matter (PM). Nevertheless, research on the risks of exposure associated with this source is scarce, and a better understanding of respiratory deposition of smoke particles is needed. The dosimetry model ExDoM2 was applied to determine the deposited dose of inhalable particulate matter (PM10) from residential biomass combustion in the human respiratory tract (HRT) of adults and children. The dose was estimated using PM10 exposure concentrations obtained from a field campaign carried out in two households during the operation of an open fireplace and a woodstove. Simultaneously, PM10 levels were monitored outside to investigate the outdoor dose in a rural area strongly impacted by biomass burning emissions. Indoors, the 8-h average PM10 concentrations ranged from 88.3 to 489 µg m-3 and from 69.4 to 122 µg m-3 for the operation of the fireplace and the woodstove, respectively, while outdoor average PM10 concentrations ranged from 17.3 to 94.2 µg m-3. The highest amount of the deposited particles was recorded in the extrathoracic region (68-79%), whereas the deposition was much lower in the tracheobronchial tree (5-6%) and alveolar-interstitial region (16-21%). The total dose received while using the fireplace was more than twofold the one received in the room with a woodstove and more than 10 times higher than in the absence of the source. Overall, indoor doses were higher than the ones received by a subject exposed outdoors, especially at the alveolar-interstitial region. After 24 h of exposure, it was estimated that approximately 35 to 37% of the particles deposited in the HRT were transferred to the gastrointestinal tract, while approximately 2.0-2.5% were absorbed into the blood. The results from exposure and dose of indoor particles gathered in this work suggest that homeowners should be encouraged to upgrade the wood burning technology to reduce the PM levels inside their residences. This study also provides biologically relevant results on the lung deposition of particles from residential biomass burning that can be used as a reference for future research.

Analysis of spatial factors, time-activity and infiltration on outdoor generated PM2.5 exposures of school children in five European cities.

Atmospheric particles are a major environmental health risk. Assessments of air pollution related health burden are often based on outdoor concentrations estimated at residential locations, ignoring spatial mobility, time-activity patterns, and indoor exposures. The aim of this work is to quantify impacts of these factors on outdoor-originated fine particle exposures of school children. We apply nested WRF-CAMx modelling of PM2.5 concentrations, gridded population, and school location data. Infiltration and enrichment factors were collected and applied to Athens, Kuopio, Lisbon, Porto, and Treviso. Exposures of school children were calculated for residential and school outdoor and indoor, other indoor, and traffic microenvironments. Combined with time-activity patterns six exposure models were created. Model complexity was increased incrementally starting from residential and school outdoor exposures. Even though levels in traffic and outdoors were considerably higher, 80-84% of the exposure to outdoor particles occurred in indoor environments. The simplest and also commonly used approach of using residential outdoor concentrations as population exposure descriptor (model 1), led on average to 26% higher estimates (15.7 µg/m3) compared with the most complex model (# 6) including home and school outdoor and indoor, other indoor and traffic microenvironments (12.5 µg/m3). These results emphasize the importance of including spatial mobility, time-activity and infiltration to reduce bias in exposure estimates.

Mediterranean Spotted Fever in Children: Study of a Portuguese Endemic Region.

INTRODUCTION: Mediterranean spotted fever is an infectious disease included in the human rickettsiosis group, with its main distribution in the Mediterranean and South European countries. It is an endemic disease in Portugal, with dogs acting as the main domestic reservoir. Children are a particularly vulnerable group due to their close contact with household animals and by frequently playing outdoors. In this study, we aim to describe the local epidemiology and characterize the clinical features and treatment options in a Portuguese endemic region. MATERIALS AND METHODS: We performed a prospective descriptive study of the Mediterranean spotted fever cases admitted to the paediatrics emergency department of a of a group II hospital, between January 1st 2013 and December 31st 2015. All patients were examined by a physician, who was later asked to fill out a detailed questionnaire regarding clinical presentation, diagnostic attitudes and treatment of their patients. Parents were later interviewed and questioned about post-discharge disease evolution. RESULTS: We registered 32 cases (93.9% reported between July and October). After fever, the most frequent reported symptoms were myalgia (37.5%), abdominal pain (25%) and headache (25%). Exanthema was present in 84.4% of cases by the third day of fever:maculonodular (53.1%), papular (37.5%) and macular (9.4%). Eschars were found in 59% of patients, with regional lymphadenopathypresent in 46.9% of cases. Azithromycin (84.4%) and doxycycline (15.5%) were the selected treatments in our population, with no cases of therapeutic failure or side-effects reported. CONCLUSION: The incidence of Mediterranean spotted fever is higher in our population in comparison with the rest of the country. Fever, myalgia, abdominal pain and headache were the most common presenting symptoms, while exanthema was the predominant cutaneous finding. Azithromycin was the preferred treatment and it proved to be successful and safe in all cases.

Introdução: A febre escaro-nodular é uma doença infeciosa aguda incluída no grupo das rickettsioses humanas, que atinge sobretudo os países da bacia do Mediterrâneo e sul da Europa. É uma doença endémica em Portugal com o cão como principal reservatório doméstico. As crianças são um grupo particularmente vulnerável devido ao contato próximo com animais domésticos e a brincarem em campos e jardins. O principal objetivo deste estudo foi perceber e estudar a epidemiologia local, bem como caracterizar a clinica e a resposta terapêutica da nossa população. Material e Métodos: Foi realizado um estudo prospetivo descritivo de todas as crianças com febre escaro-nodular admitidas no serviço de urgência de um hospital grupo II, entre janeiro de 2013 e dezembro de 2015. Todos os doentes foram avaliados por médico, que respondeu a um questionário referente as manifestações clínicas apresentadas e atitudes de diagnóstico e terapêuticas instituídas. Os pais foram posteriormente contatados, por telefone, e questionados sobre a evolução da doença. Resultados: Foram registados 32 casos (93,9% de julho a outubro). Além da febre, as queixas mais frequentes foram mialgias (37,5%), dor abdominal e cefaleias (25%). O exantema estava presente no terceiro dia de febre em 84,4%: maculopapulonodular (53,1%); papular (37,5%) e macular (9,4%). Foi identificada escara em 59% e adenopatia satélite em 46,9%. Azitromicina (84,4%) ou doxiciclina (15,5%) foram os antibióticos de escolha, com sucesso em qualquer dos casos. Não foram relatadas complicações. Conclusão: A incidência de febre escaro-nodular na nossa população é alta, quando comparada com a incidência no restante país. Febre, mialgias e cefaleias foram os principais sintomas e sinais registados enquanto a presença de exantema foi o achado dermatológico predominante. Azitromicina, antibiótico de escolha na maioria dos casos, mostrou ser eficaz.

Effectiveness of crisis resolution and home treatment teams in mental health crisis: a systematic review protocol / A efetividade das equipas de hospitalização domiciliária psiquiátrica: um protocolo de revisão sistemática / La efectividad de los equipos de hospitalización domiciliaria de atención psiquiátrica: un protocolo de revisión sistemática

Abstract Background: People with mental health crises may need intensive care support that, in many countries, implies a psychiatric hospitalization that may negatively affect the individual. Furthermore, it involves the individuals' removal from their daily spaces, which implies an adaptive effort when returning to the community. In order to reduce the treatment's impact of a mental health crisis, Crisis Resolution or Home Treatment (CRHT) Teams have been providing an alternative to inpatient treatment. Aim: To analyze and highlight CRHT teams' effectiveness in reducing days of treatment, relapse, and rehospitalization of adults (18-65 years) compared to treatment as usual defined as inpatient treatment. Methods: We will develop a systematic review of the current literature by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Two authors will independently conduct study inclusion, data extraction, quality, and bias risk assessments. We will include experimental study designs like randomized clinical trials, non-randomized, quasi-experimental, before and after studies, prospective and retrospective cohort studies, and case-control studies involving working-age adults (18-65 years) irrespective of culture, ethnicity, or mental health diagnosis. Results: We will include primary outcomes like days of treatment, relapse (as defined by each study), and rehospitalization. Secondary outcomes will be service user satisfaction, dropout rate, and the proportion of patients with adverse events (suicide, self-harm, or aggression/violence). Conclusions: This study will allow evidence to determine the need to create and encourage the implementation of CRHT teams to provide an effective alternative response to psychiatric hospitalization.

Resumo Contexto: A pessoa em crise de saúde mental pode precisar de tratamento intensivo que, em muitos países, implica um internamento psiquiátrico que pode afetar negativamente o indivíduo. Além disso, envolve o seu afastamento dos espaços quotidianos, o que implica um esforço adaptativo ao retornar à comunidade. A fim de reduzir o impacto do tratamento de uma crise de saúde mental, as Equipes de Hospitalização Domiciliária Psiquiátrica (EHDP) constituem-se como alternativa ao internamento hospitalar. Objetivo: Analisar e evidenciar a eficácia das EHDP na redução de dias de tratamento, recaídas e reinternamento de adultos (18-65 anos) em comparação com o tratamento usual definido como internamento hospitalar. Métodos: Desenvolveremos uma revisão sistemática da literatura de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2019 Statement. Dois autores conduzirão independentemente a inclusão de estudos, a extração de dados, a avaliação da qualidade e do risco de viés. Incluiremos estudos experimentais como ensaios clínicos randomizados, não randomizados, quase-experimentais, estudos pré e pós-teste, estudos de coorte prospetivos e retrospetivos e estudos de caso-controle envolvendo adultos em idade ativa (18-65 anos), independentemente da cultura, etnia ou diagnóstico de saúde mental. Resultados: Incluiremos outcomes primários como dias de tratamento, recaída (conforme definido por cada estudo) e reinternamento. Os outcomes secundários incluem a satisfação do cliente com o serviço, taxa de abandono e proporção de pacientes com eventos adversos (suicídio, automutilação ou agressão/violência). Conclusões: Este estudo trará evidências para determinar a necessidade de criar e incentivar a implementação de EHDP como uma resposta alternativa eficaz ao internamento psiquiátrico.

Resumen Contexto: Las personas con crisis de salud mental pueden necesitar apoyo en cuidados intensivos que, en muchos países, implica una hospitalización psiquiátrica que puede afectar negativamente al individuo. Además, implica la salida de los individuos de sus espacios cotidianos, lo que implica un esfuerzo adaptativo al regresar a la comunidad. Para reducir el impacto del tratamiento de una crisis de salud mental, los equipos de resolución de crisis o de tratamiento en el hogar (ERCTH) han estado brindando una alternativa al tratamiento hospitalario. Objetivo: Analizar y destacar la efectividad de los ERCTH en la reducción de días de tratamiento, recaída y rehospitalización de adultos (18-65 años) en comparación con el tratamiento habitual definido como tratamiento hospitalario. Metodología: Desarrollaremos una revisión sistemática de la literatura actual mediante la Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Dos autores realizarán de forma independiente la inclusión de los estudios, la extracción de datos, las evaluaciones de la calidad y riesgo de sesgo. Incluiremos diseños de estudios experimentales como ensayos clínicos aleatorizados, no aleatorizados, cuasiexperimentales, estudios de antes y después, estudios de cohortes prospectivos y retrospectivos, y estudios de casos y controles con adultos en edad laboral (18-65 años) independientemente de la cultura, origen étnico o diagnóstico de salud mental. Resultados: Incluiremos resultados primarios como días de tratamiento, recaída (según la definición de cada estudio) y rehospitalización. Los resultados secundarios será la satisfacción del cliente del servicio, la tasa de abandono y la proporción de pacientes con eventos adversos (suicidio, autolesiones o agresión/violencia). Conclusiones: Este estudio aportará evidencias para determinar la necesidad de crear y fomentar la implementación de ERCTH para ofrecer una respuesta alternativa efectiva a la hospitalización psiquiátrica.

Early childhood screen time and psychopathology in a Portuguese Sample / Tempo de tela na Primeira Infância e psicopatologia numa amostra portuguesa / Tiempo de pantalla en la primera infancia y psicopatologia en una muestra portuguesa

Objective: To characterize the habits of screen exposure time in a sample of infants and preschoolers and to assess if there is a relationship between the proportion of early childhood excessive screen exposure time and the presence of psychopathology and parental concerns. Methods: A cross-sectional cohort study was conducted with 38 infants and preschoolers in a Child and Adolescent Psychiatric outpatient unit and children followed exclusively in Primary Health Care in the same geographic area (Vila Nova de Gaia/ Espinho Hospital Center). Information was collected from a self-report questionnaire filled by the caregiver between October 1st, 2018, and June 30th, 2019. Results: Screen time was analyzed and organized in two groups: the H group (screen time higher than recommended) and R group (within the recommended), according to the American Academy of Pediatrics. The need for referral to a Child and Adolescent Psychiatry appointment and the presence of parental behavior concerns related to behavior changes during early childhood are significantly associated with screen time, with a greater proportion within the H group (71.8% (n=15) vs. 31.3% (n=6), p=0.006 for the appointment and 61.1% (n=13) vs. 25% (n=4), p=0.032 for behavior concerns). There is also a tendency towards a higher percentage of overweight/obesity, sleep and food-related concerns in the H group. Only 45% of the total sample fulfilled the recommendations regarding screen exposure (p value ≤0.05). Conclusion: The study found an association between screen exposure time above the recommended and presence of psychopathology and parental concern for behavioral changes. These findings were statistically significant

Objetivo: Pretende-se caracterizar os hábitos de exposição e tempo de tela numa amostra de crianças da primeira infância para avaliar a relação entre a exposição excessiva e a presença de psicopatologia e preocupações parentais. Métodos: Tratase de um estudo de coorte transversal realizado com 38 crianças da primeira infância da Consulta Externa de Psiquiatria da Infância e Adolescência e crianças acompanhadas exclusivamente em consulta de Cuidados de Saúde Primários da área de referência do Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal. Recolheu-se a informação através do preenchimento de um questionário pelo cuidador, entre 1 de Outubro de 2018 e 30 de Junho de 2019. Resultados: Analisou-se o tempo de tela, definindo-se dois grupos: H ­ tempo de tela superior ao recomendado; R ­ tempo de tela dentro do recomendado pela Academia Americana de Pediatria. A necessidade de acompanhamento em consulta de Pedopsiquiatria e as preocupações parentais relativas a alterações de comportamento estão significativamente associadas com o tempo de tela, com maior proporção no grupo H (71,8%(n=15) vs. 31.3%(n=6), p=0.006 para a consulta de Pedopsiquiatria e 61.1%(n=13) vs. 25%(n=4), p=0.032 para preocupações parentais). Existe ainda uma tendência a uma percentagem mais significativa de excesso de peso/obesidade, problemas de sono e alimentares no grupo H. Apenas 45% do total cumpriu as recomendações relativas ao tempo de tela (valor de p≤0,05). Conclusão: Este estudo demonstrou associação entre o tempo de tela superior ao recomendado e presença de psicopatologia, assim como preocupações parentais com alterações de comportamento. Estes resultados apresentam significância estatística.

Objetivo: Se pretende caracterizar los hábitos de exposición y tiempo de pantalla en una muestra de niños en la primera infancia para evaluar la relación entre la exposición excesiva y la presencia de psicopatología y preocupaciones parentales. Métodos: Se trata de un estudio de coorte transversal realizado con 38 niños en la primera infancia de la Consulta Externa de Psiquiatría de la Niñez y Adolescencia y niños acompañados exclusivamente en consulta de Cuidados de Salud Primarios del área de referencia del Centro Hospitalario de Vila Nova de Gaia/ Espinho, Portugal. Las informaciones fueron recogidas por medio de cuestionario, rellenado por el cuidador, entre 1 de Octubre de 2018 y 30 de Junio de 2019. Resultados: El tiempo de pantalla fue analizado definiéndose dos grupos: H ­ tiempo de pantalla superior al recomendado; R ­ tiempo de pantalla dentro del recomendado por la Academia Americana de Pediatría. La necesidad de acompañamiento en consulta de psiquiatría infantil y las preocupaciones parentales relativas a alteraciones de comportamiento están significativamente asociadas con tiempo de pantalla, con mayor proporción en el grupo H (71,8%(n=15) vs. 31.3%(n=6), p=0.006 para la consulta de psiquiatría infantil y 61.1%(n=13) vs. 25%(n=4), p=0.032 para preocupaciones parentales). Existe aún una tendencia a un porcentaje más significativo de exceso de peso/obesidad, problemas de sueño y alimentarios en el grupo H. Solo 45% del total cumplió las recomendaciones relativas al tiempo de pantalla (valor de p≤0.05). Conclusión: Este trabajo demostró asociación entre el tiempo de pantalla superior al recomendado y presencia de psicopatología, como también preocupaciones parentales con alteraciones de comportamiento. Estos resultados presentan significancia estadística.

HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus

ABSTRACT Objectives: Evaluate the celiac disease (CD) markers, within the scope of its screening, in a pediatric population with diagnosis of type 1 diabetes (T1D) at Hospital de Braga (HB) and determine the prevalence of CD in the sample. Reflect on CD screening algorithm applied in this pediatric population. Subjects and methods: Retrospective observational study with 94 patients diagnosed with T1D at age 10 years or younger, followed up at the HB Outpatient Diabetology Consultation, including those referred from other hospitals. Record of clinical information, IgA anti-transglutaminase and anti-endomysium and HLA DQ2/DQ8 haplotypes. Results: We obtained positive serological test for CD in 4 patients. This test had 100% sensitivity and specificity. The prevalence of CD was 4.3% (n = 4). Positive HLA screening in 84.6% of patients, with both sensitivity and negative predictive value of 100% and specificity of 16.67%. Diagnosis of CD was made on average 3.40 ± 3.32 years after the diagnosis of TD1. All cases of CD registered non-gastrointestinal manifestations, none had gastrointestinal symptoms. Conclusion: This study proved that there is a higher prevalence of CD in pediatric population with TD1, when compared to general population, and clarified the importance of CD screening. Furthermore, it was observed that serological screening for CD antibodies is an excellent screening test and HLA typing, although not the most suitable first line test, can be useful in excluding the possibility of patients with T1D developing CD.

Identification of technical problems affecting performance of DustTrak DRX aerosol monitors.

The TSI DustTrak Aerosol Monitor is a portable real-time instrument widely used for particulate matter (PM) mass concentrations monitoring. The aim of this work is to report on issues that have arisen from the use of the latest generation models DustTrak DRX (8533 and 8534) in the BREATHE, UPTECH and IMPROVE projects that can compromise data quality. The main issue we encountered was the occurrence of sudden artefact jumps in PM concentration, which can involve an increase from a few to some hundreds of µg·m-3. These artefact jumps can sometimes be easily recognised ("obvious jump"), while others can be difficult to identify because the difference in the concentrations before and after the jump might be just few µg·m-3 ("possible jump") or because the jump is sustained over the whole monitoring period and only detectable if PM concentrations are simultaneously measured by other instruments ("hidden jump"). Moreover, in areas of relatively low PM levels, the unit reported concentration of 0µg·m-3 for ambient PM concentration or even negative concentration values which may seriously compromise the dataset. These data suggest issues with the detection of low PM concentrations, which could be due to an incorrect instrument offset or the factory calibration setting being inadequate for these PM concentrations. The upward and downward artefact jumps were not related to especially dusty or clean conditions, since they have been observed in many kinds of environments: indoor and outdoor school environments, subway stations and in ambient urban background air. Therefore, PM concentration data obtained with the TSI DustTrak DRX models should be handled with care and meticulously revised before being considered valid. To prevent these issues the use of auto zero module is recommended, so the DustTrak monitor is automatic re-zeroed without requiring the presence of any user.

Adolescer Saudável: screening and follow-up of risk at school / Adolescer Saudável: rastreio e seguimento do risco na escola

ABSTRACT Objective To characterize adolescents referred to medical consultation based on the screening tool "Perfil de Saúde do Utente Adolescente", and to compare to information gathered from a questionnaire and data assessed during the visit. Methods A retrospective and descriptive study, with analysis of the questionnaires filled out by adolescents and their respective medical records, in the period from January 2013 to June 2016. Results A total of 54 adolescents were seen, 57% male and mean age of 12±1.7 years. In the questionnaire, 37% stated that they had some kind of health problem; 35% would like to change the relationship with their parents; 18% had some concern about safety at school; and 39% made dietary mistakes. Approximately 31% had consumed alcohol, 13% had tried smoking, and 4% had used other drugs. At the first medical appointment, 38% stated they had chronic disease, 11% reported poor family environment, 39% had school problems and 39% made dietary mistakes. About 13% had tried smoking, 24% had tried to consume alcohol, and 2% had tried other drugs. Thirty seven percent of adolescents were referred to adolescent medicine consultation, and 39% to another hospital consultation. Conclusion Many of the biopsychosocial risk items identified through the questionnaire were confirmed during consultation, indicating that it could be a useful screening method for problems linked to the adolescence period.

RESUMO Objetivo Caracterizar adolescentes referenciados à consulta médica a partir do instrumento de triagem Perfil de Saúde do Utente Adolescente e comparar as informações obtidas do questionário e os dados avaliados na consulta. Métodos Estudo retrospectivo e descritivo, com análise dos questionários preenchidos por adolescentes e respectivos processos clínicos da consulta realizada no período de janeiro de 2013 a junho de 2016. Resultados Foram consultados 54 adolescentes, 57% do sexo masculino, com média de idade 12±1,7 anos. No questionário, 37% responderam ter algum problema de saúde; 35% gostariam de mudar a relação com os pais; 18% tinham algum tipo de preocupação com a segurança na escola; e 39% cometiam erros alimentares. Aproximadamente 31% já tinham consumido álcool, 13% já tinham experimentado fumar, e 4% tinham experimentado outras drogas. Na primeira consulta, 38% dos respondentes responderam ter doença crônica, 11% referiram mau ambiente familiar, 39% apresentaram problemas escolares e 39% revelaram erros alimentares. Cerca de 13% experimentaram fumar, 24% consumiram álcool, e 2% experimentaram outras drogas. Foram referenciados à consulta de medicina do adolescente 37% dos adolescentes, e 39% foram direcionados a outra consulta hospitalar. Conclusão Em consulta, confirmaram-se muitos dos itens de risco biopsicossocial identificados por meio do questionário aplicado, o que pode indicar que este é um método útil no rastreio de problemática ligada à adolescência.