Comparative epidemiological study of breast cancer in humans and canine mammary tumors: insights from Portugal.

Dogs spontaneously develop mammary gland tumors (MGT) and exhibit striking similarities in clinical and epidemiological characteristics to human breast cancer (HBC). Descriptive and comparative analysis of HBC and canine MGT with a focus on evaluating similarities and geographical distribution were the aims of this study. HBC cases were obtained from North Regional Oncological Registry (RORENO) (2010-2015) and canine MGT cases from Vet-OncoNet (2019-2022). Analyses were performed based on published and well accepted classification systems (ICD-O-3.2 for humans and Vet-ICD-O-canine-1). Age-standardized incidence risks (ASIR) of Porto district municipalities were calculated using 2021 Portuguese census (INE) and data from the Portuguese animal registration system (SIAC). Among 7,674 HBC cases and 1,140 MGT cases, a similar age and sex distribution pattern was observed. Approximately 69.2% of HBC cases were between 40 and 69 years old, while 66.9% of MGT cases were diagnosed between 7 and 12 years old (mean age of 9.6 years, SD = 2.6). In women, Invasive breast carcinoma (8500/3) was the most common histological type (n = 5,679, 74%) while in dogs it was the Complex Carcinoma (8983.1/3) (n = 205, 39%). Cocker and Yorkshire Terriers exhibited the highest relative risks (3.2 and 1.6, p < 0.05, respectively) when compared to cross breed dogs. The municipalities' ASIR of the two species exhibited a high correlation (R = 0.85, p < 0.01) and the spatial cluster analysis revealed similar geographic hotspots. Also, higher ASIR values both in women and dogs were more frequently found in urbanized areas compared to rural areas. This research sheds light on the shared features and geographical correlation between HBC and canine MGT, highlighting the potential of cross-species environmental oncology studies.

Geographic patterns and hotspots of pediatric tuberculosis: the role of socioeconomic determinants / Padrões geográficos e focos de tuberculose pediátrica: o papel de determinantes socioeconômicos

ABSTRACT Objective: Children are an important demographic group for understanding overall tuberculosis epidemiology, and monitoring of childhood tuberculosis is essential for appropriate prevention. The present study sought to characterize the spatial distribution of childhood tuberculosis notification rates in continental Portugal; identify high-risk areas; and evaluate the association between childhood tuberculosis notification rates and socioeconomic deprivation. Methods: Using hierarchical Bayesian spatial models, we analyzed the geographic distribution of pediatric tuberculosis notification rates across 278 municipalities between 2016 and 2020 and determined high-risk and low-risk areas. We used the Portuguese version of the European Deprivation Index to estimate the association between childhood tuberculosis and area-level socioeconomic deprivation. Results: Notification rates ranged from 1.8 to 13.15 per 100,000 children under 5 years of age. We identified seven high-risk areas, the relative risk of which was significantly above the study area average. All seven high-risk areas were located in the metropolitan area of Porto or Lisbon. There was a significant relationship between socioeconomic deprivation and pediatric tuberculosis notification rates (relative risk = 1.16; Bayesian credible interval, 1.05-1.29). Conclusions: Identified high-risk and socioeconomically deprived areas should constitute target areas for tuberculosis control, and these data should be integrated with other risk factors to define more precise criteria for BCG vaccination.

RESUMO Objetivo: As crianças são um grupo demográfico importante para a compreensão da epidemiologia da tuberculose em geral, e o monitoramento da tuberculose infantil é essencial para a prevenção adequada. O presente estudo procurou caracterizar a distribuição espacial das taxas de notificação de tuberculose infantil em Portugal continental; identificar áreas de alto risco e avaliar a associação entre taxas de notificação de tuberculose infantil e privação socioeconômica. Métodos: Por meio de modelos espaciais hierárquicos bayesianos, analisamos a distribuição geográfica das taxas de notificação de tuberculose pediátrica em 278 municípios entre 2016 e 2020 e determinamos as áreas de alto e baixo risco. Usamos a versão portuguesa do European Deprivation Index para calcular a associação entre a tuberculose infantil e a privação socioeconômica em cada área. Resultados: As taxas de notificação variaram de 1,8 a 13,15 por 100.000 crianças com idade < 5 anos. Identificamos sete áreas de alto risco, cujo risco relativo era significativamente maior que a média da área de estudo. Todas as sete áreas de alto risco situavam-se na área metropolitana do Porto e de Lisboa. Houve uma relação significativa entre a privação socioeconômica e as taxas de notificação de tuberculose pediátrica (risco relativo = 1,16; intervalo de credibilidade de 95%: 1,05-1,29). Conclusões: Áreas identificadas como sendo de alto risco e desfavorecidas socioeconomicamente devem constituir áreas-alvo para o controle da tuberculose, e esses dados devem ser integrados a outros fatores de risco para definir critérios mais precisos para a vacinação com BCG.

Active Neutralizing Mats for Corrosive Chemical Storage.

Laboratories and industries that handle chemicals are ubiquitously prone to leakages. These may occur in storage rooms, cabinets or even in temporary locations, such as workbenches and shelves. A relevant number of these chemicals are corrosive, thus commercial products already exist to prevent material damage and injuries. One strategy consists of the use of absorbing mats, where few display neutralizing properties, and even less a controlled neutralization. Nevertheless, to the authors' knowledge, the commercially available neutralizing mats are solely dedicated to neutralizing acid or alkali solutions, never both. Therefore, this work describes the development and proof of a completely novel concept, where a dual component active mat (DCAM) is able to perform a controlled simultaneous neutralization of acid and alkali leakages by using microencapsulated active components. Moreover, its active components comprise food-grade ingredients, embedded in nonwoven polypropylene. The acid neutralizing mats contain sodium carbonate (Na2CO3) encapsulated in sodium alginate microcapsules (MC-ASC). Alkali neutralizing mats possess commercial encapsulated citric acid in hydrogenated palm oil (MIRCAP CT 85-H). A DCAM encompasses both MC-ASC and MIRCAP CT 85-H and was able to neutralize solutions up to 10% (v/v) of hydrochloric acid (HCl) and sodium hydroxide (NaOH). The efficacy of the neutralization was assessed by direct titration and using pH strip measurement tests to simulate the leakages. Due to the complexity of neutralization efficacy evaluation based solely on pH value, a thorough conductivity study was performed. DCAM reduced the conductivity of HCl and NaOH (1% and 2% (v/v)) in over 70%. The composites were characterized by scanning electron microscopy (SEM), differential calorimetry (DSC) and thermogravimetric analysis (TGA). The size of MC-ASC microcapsules ranged from 2 µm to 8 µm. Finally, all mat components displayed thermal stability above 150 °C.

Association of neighbourhood disadvantage and individual socioeconomic position with all-cause mortality: a longitudinal multicohort analysis.

BACKGROUND: Few studies have examined the interactions between individual socioeconomic position and neighbourhood deprivation and the findings so far are heterogeneous. Using a large sample of diverse cohorts, we investigated the interaction effect of neighbourhood socioeconomic deprivation and individual socioeconomic position, assessed using education, on mortality. METHODS: We did a longitudinal multicohort analysis that included six cohort studies participating in the European LIFEPATH consortium: the CoLaus (Lausanne, Switzerland), E3N (France), EPIC-Turin (Turin, Italy), EPIPorto (Porto, Portugal), Melbourne Collaborative Cohort Study (Melbourne, VIC, Australia), and Whitehall II (London, UK) cohorts. All participants with data on mortality, educational attainment, and neighbourhood deprivation were included in the present study. The data sources were the databases of each cohort study. Poisson regression was used to estimate the mortality rates and associations (relative risk, 95% CIs) with neighbourhood deprivation (Q1 being least deprived to Q5 being the most deprived). Baseline educational attainment was used as an indicator of individual socioeconomic position. Estimates were combined using pooled analysis and the relative excess risk due to the interaction was computed to identify additive interactions. FINDINGS: The cohorts comprised a total population of 168 801 individuals. The recruitment dates were 2003-06 for CoLaus, 1989-91 for E3N, 1992-98 for EPIC-Turin, 1999-2003 for EPIPorto, 1990-94 for MCCS, and 1991-94 for Whitehall II. We use baseline data only and mortality data obtained using record linkage. Age-adjusted mortality rates were higher among participants residing in more deprived neighbourhoods than those in the least deprived neighbourhoods (Q1 least deprived neighbourhoods, 369·7 per 100 000 person-years [95% CI 356·4-383·2] vs Q5-most deprived neighbourhoods 445·7 per 100 000 person-years [430·2-461·7]), but the magnitude of the association varied according to educational attainment (relative excess risk due to interaction=0·18, 95% CI 0·08-0·28). The relative risk for Q5 versus Q1 was 1·31 (1·23-1·40) among individuals with primary education or less, but less pronounced among those with secondary education (1·12; 1·04-1·21) and tertiary education (1·16; 1·07-1·27). Associations remained after adjustment for individual-level factors, such as smoking, physical activity, and alcohol intake, among others. INTERPRETATION: Our study suggests that the detrimental health effect of living in disadvantaged neighbourhoods is more pronounced among individuals with low education attainment, amplifying social inequalities in health. This finding is relevant to policies aimed at reducing health inequalities, suggesting that these issues should be addressed at both the individual level and the community level. FUNDING: The European Commission, European Regional Development Fund, the Portugese Foundation for Science and Technology.

Relationship between green space near schools with physical activity and body mass index in portuguese adolescents / Relação entre o espaço verde próximo a escola com a atividade física e índice de massa corporal em adolescentes portugueses

Our aim was to determine the relationship between urban green spaces (UGS) number and green-ness amount close to school with physical activity (PA) and body mass index (BMI) of adoles-cents. Participants (n = 194, aged 13­18 years) were recruited in 75 public secondary schools in the Porto Metropolitan Area. We used a self-administered questionnaire to obtain information on height, weight, age and sex. PA levels were assessed using accelerometers. UGS number and green-ness amount were measured using network buffers by 300, 500, 1000 and 1500 meters around each school, through geographic information system and normalized difference vegetation index (NDVI), respectively. Multilevel regressions were fitted to each green indicator individually. Multilevel models without adjustment showed a direct relationship between PA and NDVI [B = 118.14; 95%CI: 20.71, 215.57] and inverse relationship between PA and UGS number [B = -5.95; 95%CI: -10.06, -1.83] at 300 meters. Multilevel models with adjustment for socioeconomic deprivation showed a direct relationship between BMI and NDVI [B = 83.41; 95%CI: 30.84, 135.98] at 500 meters and a direct relationship between BMI and NDVI [B = 61.68; 95%CI: 3.07, 120.29] at 1000 meters. The present investigation does not support the idea that UGS number and the NDVI close to school promote PA and metabolic health in adolescents, as the results proved to be inconsistent and dependent on the distance threshold used to define geographic proximity

O objetivo foi determinar a relação entre quantidade de espaços verdes (EV ) e quantidade de vegetação na proximidade da escola com a atividade física (AF) e índice de massa corporal (IMC) em adolescentes. Os participantes (n = 194, com idades de 13 a 18 anos) foram recrutados em 75 escolas públicas secundárias da Área Metropolitana do Porto. Altura, peso, idade e sexo foram reportadas por questionário e a AF avaliada por acelerómetros. A quantidade de EV e de vegetação foram medidas em buffers de 300, 500, 1000 e 1500 metros ao redor da escola, através de Sistema de Informação Geográfica e índice de vegetação por diferença normalizada (IVDN), respetivamente. Regressões multinível foram realizadas individualmente com cada indicador de verde. A regressões sem ajuste demonstraram relação direta entre a AF e IVDN [B = 118,14; IC95%: 20,71; 215,57] e relação inversa entre a AF e quantidade de EV [B = -5,95; IC95%: -10,06; -1,83] a 300 metros. Modelos ajustados para a privação socioeconómica, apontaram relação direta entre a AF e IVDN [B = 130,18; IC95%: 7,30; 253,07], relação inversa entre a AF e quantidade de EV [B = -5,67; IC95%: -9,87; -1,47] a 300 metros, relação direta entre o IMC e IVDN a 500 [B = 61,68 ;IC95%: 3,07; 120,29] e a 1000 metros [B = 67,68; IC95%: 3,07; 120,29]. A presente investigação não suporta a ideia de que os EV e o IVDN próximos da escola promovem a AF e a saúde metabólica dos adolescentes, pois os resul-tados foram inconsistentes e dependentes do limiar de distância usado para definir proximidade geográfica

Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal.

INTRODUCTION AND OBJECTIVES: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. MATERIALS AND METHODS: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. RESULTS: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. CONCLUSIONS: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases.

The importance of socioeconomic position in smoking, cessation and environmental tobacco smoke exposure during pregnancy.

Tobacco is still a leading cause of premature death and morbidity. Particular attention has been given to pregnant women due to the scientific evidence on the importance of early life exposures for disease onset later in life. The purpose of this study was to assess smoking prevalence, smoking cessation rate and environmental tobacco smoke (ETS) exposure, and the role of socioeconomic position (SEP) on these behaviors among pregnant women. Cross-sectional data of 619 pregnant women, aged between 18 and 46 years, from Porto Metropolitan Area, Portugal, on current smoking, ETS exposure and SEP indicators was collected, face-to-face, using a questionnaire filled in during a personal interview at the postpartum hospital stay. The smoking prevalence, and ETS exposure among non-smokers before pregnancy was 27.6% and 57.4%, respectively. 4.1% of the participants reported to have stopped smoking before pregnancy, whereas about 41% quitted along pregnancy, resulting in a smoking prevalence at birth of 14.6%. Exposure to ETS also decreased throughout pregnancy to 49.8% at birth. Lower educational level was significantly associated with both higher smoking prevalence and exposure to ETS and lower smoking cessation. This study demonstrates that smoking and ETS exposure during pregnancy remains high, and that there are still significant socioeconomic inequalities in smoking; thus tobacco-focused preventive interventions need to be reinforced.

The influence of species richness in primary school surroundings on children lung function and allergic disease development.

BACKGROUND: Primary schools represent important environments for biodiversity exposure and thus may play a crucial role on early-life immunomodulation, protecting against allergic sensitization. The aim of this study was to understand how the exposure to different levels of species richness surrounding urban primary schools may influence the development of allergic diseases and asthma in children. METHODS: A species richness index (SRI), evaluating habitat diversity in terms of amphibians, birds, reptiles, and small mammals, was estimated and attributed to 20 primary schools in the city of Porto, Portugal. The SRI was measured considering a 100 m straight-line buffer around the schools. Children who attended the participating schools were invited to participate in the study, performed spirometry with bronchodilation and skin-prick tests, and had their parents fill a questionnaire concerning allergy and asthma symptoms, as well as demographic and socioeconomic data. Asthma was defined according to three distinct criteria. RESULTS: The study results showed significant and positive associations between the exposure to species richness in schools and the forced expiratory volume at the first second (FEV1 ) and forced vital capacity (FVC) parameters both before and after bronchodilation, independently of the asthma and atopic status. Fully adjusted models revealed that a unitary increment in the SRI was associated with an average increase of approximately 2 and 3 mL in FEV1 and FVC, respectively. CONCLUSION: Species richness in school surroundings may impact lung function development in children. However, this increase in lung function was not associated with any clinically relevant protective effect on allergy and asthma development.

Oral leishmaniasis: Report of two cases.

Leishmaniasis is a chronic inflammatory disease caused by several species of the parasite Leishmania that is transmitted by insects of the genus Phlebotomus spp. or Lutzomyia spp. This disease can affect skin, mucous membranes and viscera being classified as cutaneous, mucocutaneous and visceral leishmaniasis, depending on the spectrum of clinical manifestations. Diagnosis can be achieved through biopsy, microscopical analysis, Montenegro intradermoreaction and/or ELISA. The dentist plays an important role in the diagnosis of this disease due to frequent involvement of oral mucosa. This article reports two clinical cases of leishmaniasis with oral mucosa involvement, their diagnosis workup and treatment.

Bacteriúria assintomática na gravidez de baixo risco ­ qual a evidência do seu tratamento? / Asymptomatic bacteriuria in low-risk pregnancy - what is the evidence of its treatment? / Bacteriuria asintomática en el embarazo de bajo riesgo ­ ¿cuál es la evidencia de su tratamiento?

A bacteriúria assintomática (BUA) tem estado associada a aumento do risco de pielonefrite materna e parto pré-termo. As normas de orientação clínica internacionais recomendam a sua pesquisa e tratamento durante a gravidez. No entanto, os benefícios e riscos da sua pesquisa e tratamento não são consensuais. Esta revisão tem por objetivo analisar a evidência disponível quanto à influência do tratamento da BUA na morbimortalidade materna e fetal. Os autores realizaram pesquisa na base de dados MEDLINE e sites de Medicina Baseada na Evidência, de revisões baseadas na evidência, normas de orientação clínica, meta-análises, revisões sistemáticas e ensaios clínicos controlados e aleatorizados, utilizando os termos MeSH: Bacteriuria e Pregnancy, de artigos publicados entre janeiro de 2008 e maio de 2018, em Inglês, Francês, Espanhol e Português. Para avaliação dos níveis de evidência e atribuição de forças de recomendação, foi utilizada a escala Strength of Recommendation Taxonomy (SORT) da American Family Physician. Foram identificados 136 artigos, dos quais 10 cumpriam critérios de inclusão. A evidência existente, maioria baseada em estudos antigos com importantes limitações metodológicas, não permite concluir de forma clara se o tratamento da BUA influencia positivamente a morbimortalidade materna e fetal, no entanto dados recentes apontam para ausência de benefício com o tratamento da BUA em gravidezes únicas de baixo risco (Força de recomendação B), o que questiona a prática clínica corrente. Para colmatar as limitações dos estudos encontrados, são necessários estudos controlados, aleatorizados, de elevada qualidade e maior dimensão que avaliem a influência do tratamento da BUA na morbimortalidade materna e fetal.

Asymptomatic bacteriuria (ASB) has been associated with an increased risk of maternal pyelonephritis (PN) and preterm birth (PTB). International clinical guidelines recommend its research and treatment during pregnancy. However, the benefit and risk of screening and treating ASB is not consensual, and this review intends to analyze the available evidence regarding the influence of ASB treatment on maternal and fetal morbidity and mortality. We search on MEDLINE database and Evidence-Based Medicine sites of evidence-based reviews, clinical guidelines, meta-analysis, systematic reviews and randomized controlled trials, using the MeSH terms "Bacteriuria AND Pregnancy", of articles published between January 2008 and May 2018, in English, French, Spanish and Portuguese. The Strength of Recommendation Taxonomy (SORT) scale of the American Family Physician was used to assess the levels of evidence and assignment of recommendation forces. We identified 136 articles, of which ten met the inclusion criteria. The existing evidence, mostly based on outdated or small and with methodological shortcomings clinical trials, does not allow a clear conclusion as to whether the treatment of ASB positively influences maternal and fetal morbidity and mortality; the most recent data effectively points to a lack of benefit with ASB treatment (SOR B). To address the limitations of the studies found, controlled, randomized, higher quality and larger studies are needed to assess the influence of ASB treatment on maternal and fetal morbidity and mortality.

La bacteriuria asintomática (BUA) se ha asociado a un aumento del riesgo de pielonefritis materna y parto prematuro. Las pautas en general recomiendan la detección y tratamiento de BUA en el embarazo. Sin embargo, el beneficio y riesgo de la detección y tratamiento de la BUA no son consensuales, y esta revisión pretende analizar la evidencia disponible sobre la influencia del tratamiento de la BUA en la morbilidad y mortalidad materna y fetal. Buscamos en la base de datos MEDLINE y en los sitios de Medicina Basada en la Evidencia, de revisiones basadas en la evidencia, guías clínicas, metanálisis, revisiones sistemáticas y ensayos controlados aleatorios, utilizando los términos MeSH "Bacteriuria Y Embarazo", de artículos publicados entre enero 2008 y mayo de 2018, en inglés, francés, español y portugués. Para la evaluación de los niveles de evidencia y asignación de fuerzas de recomendación, se utilizó la escala Strength of Recommendation Taxonomy (SORT) de la American Family Physician. Se identificaron 136 artículos, de los cuales 10 cumplían los criterios de inclusión. La evidencia existente, basada principalmente en ensayos clínicos obsoletos o pequeños y con deficiencias metodológicas, no permite una conclusión clara sobre si el tratamiento de la BUA influye positivamente la morbilidad y mortalidad materna y fetal; los datos más recientes apuntan a una falta de beneficio con el tratamiento de la BUA (SOR B). Para colmar las limitaciones de los estudios encontrados se necesitan estudios controlados, aleatorizados, de mayor calidad y tamaño para evaluar la influencia del tratamiento de la BUA en la morbilidad y mortalidad materna y fetal.

Factors associated with time to breast cancer diagnosis and treatment in unscreened women in Portugal.

Delays in detection, diagnosis and treatment may lead to poorer prognosis in women with breast cancer. We quantified time intervals from first detection (FD) to diagnosis (D) and first treatment (FT) and identified associated factors. We studied 282 patients diagnosed with breast cancer during 2012 at the Breast Clinic of the Portuguese Institute of Oncology in Porto, Portugal using face-to-face interview and medical records. Associations of sociodemographic and clinical characteristics with time intervals was computed using adjusted percentage differences (adjPD) after logarithmic transformation, odds ratios (adjOR) for comparing the highest and lowest thirds of the distribution and 95 percent confidence intervals (CI) for both measures, using linear and logistic regression, respectively. The median times between FD and D and FT were 31 and 44 days, respectively. Significantly longer periods between FD and D were found in symptomatic women (adjPD = 99.5, 95 percent CI: 37.1, 190.0; adjOR = 3.16, 95 percent CI: 1.57, 6.33). More advanced stage was associated with shorter intervals between D and FT (adjPD = -33.8, 95 percent CI: -44.2, -21.5; adjOR = 0.14, 95 percent CI: 0.05, 0.34). Although some differences according to clinical characteristics were observed, they did not seem to translate into inequities in access to public healthcare in this group of women.

Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study.

OBJECTIVE: To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. DESIGN: Multi-cohort population based study. SETTING: 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017. PARTICIPANTS: 109 107 men and women aged 45-90 years. MAIN OUTCOME MEASURE: Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors. RESULTS: According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors. CONCLUSIONS: The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.

Neighbourhood socioeconomic deprivation and health-related quality of life: A multilevel analysis.

OBJECTIVE: To assess the relationship between socioeconomic deprivation and health-related quality of life in urban neighbourhoods, using a multilevel approach. METHODS: Of the population-based cohort EPIPorto, 1154 georeferenced participants completed the 36-Item Short-Form Health Survey. Neighbourhood socioeconomic deprivation classes were estimated using latent-class analysis. Multilevel models measured clustering and contextual effects of neighbourhood deprivation on physical and mental HRQoL. RESULTS: Residents from the least deprived neighbourhoods had higher physical HRQoL. Neighbourhood socioeconomic deprivation together with individual-level variables (age, gender and education) and health-related factors (smoking, alcohol consumption, sedentariness and chronic diseases) explained 98% of the total between-neighbourhood variance. Neighbourhood socioeconomic deprivation was significantly associated with physical health when comparing least and most deprived neighbourhoods (class 2-beta coefficient: -0.60; 95% confidence interval:-1.76;-0.56; class 3 -beta coefficient: -2.28; 95% confidence interval:-3.96;-0.60), and as neighbourhood deprivation increases, a decrease in all values of physical health dimensions (physical functioning, role physical, bodily pain and general health) was also observed. Regarding the mental health dimension, no neighbourhood clustering or contextual effects were found. However, as neighbourhood deprivation increases, the values of vitality and role emotional dimensions significantly decreased. CONCLUSION: Neighbourhood socioeconomic deprivation is associated with HRQoL, affecting particularly physical health. This study suggests that to improve HRQoL, people and places should be targeted simultaneously.

Development of a measure of multiple physical environmental deprivation. After United Kingdom and New Zealand, Portugal.

BACKGROUND: Spatial inequalities in health have been identified, but the contribution of physical environment has been largely ignored. In Portugal, strong spatial differences in morbidity and mortality remain unexplained. Based on previous United Kingdom (UK) and New Zealand (NZ) research, we aimed to develop a Portuguese measure of multiple environmental deprivation (PT-MEDIx) to assist in understanding spatial inequalities in health. METHODS: PT-MEDIx was built at municipality level in four stages: (i) identify health-relevant environmental factors; (ii) acquire datasets about selected environmental factors and calculate municipality-level measures using Geographical Information Systems; (iii) test associations between selected environmental factors and mortality using negative binomial models, adjusting for age, sex, socioeconomic deprivation and interactions and (iv) construct a summary measure and assess its association with mortality. RESULTS: We included five dimensions of the physical environment: air pollution, climate, drinking water quality, green space availability and industry proximity. PT-MEDIx score ranged from -1 (least environmental deprivation) to +4 (most) and depicted a clear spatial pattern: least deprived municipalities in the depopulated rural areas and most deprived in urban and industrial settings. Comparing with those in the intermediate category of environment deprivation, less deprived municipalities showed lower mortality rate ratios (MRRs) and vice versa: MRRs for all-cause mortality were 0.962 (95% confidence interval: 0.934-0.991) and 1.209 (1.086-1.344), in the least and most deprived municipalities, respectively, and for cancer, 0.957 (0.911-1.006) and 1.345 (1.123-1.598). CONCLUSIONS: The methods used to create UK and NZ indexes have good transferability to Portugal. MEDIx might contribute to untangle the complex pathways that link health, socioeconomic and physical environment.

A 63-year-old woman presenting with a synovial sarcoma of the hand: a case report.

INTRODUCTION: Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is located in the vicinity of joints, tendons or bursae, although it can also be found in extra-articular locations. Most patients with synovial sarcoma of the hand are young and have a poor prognosis, as these tumors are locally aggressive and are associated with a relatively high metastasis rate. According to the literature, local recurrence and/or metastatic disease is found in nearly 80% of patients. Current therapy comprises surgery, systemic and limb perfusion chemotherapy, and radiotherapy. However, the 5-year survival rate is estimated to be only around 27% to 55%. Moreover, most authors agree that synovial sarcoma is one of the most commonly misdiagnosed malignancies of soft tissues because of their slow growing pattern, benign radiographic appearance, ability to change size, and the fact that they may elicit pain similar to that caused by common trauma. CASE PRESENTATION: We describe an unusual case of a large synovial sarcoma of the hand in a 63-year-old Caucasian woman followed for 12 years by a multidisciplinary team. In addition, a literature review of the most pertinent aspects of the epidemiology, diagnosis, treatment and prognosis of these patients is presented. CONCLUSION: Awareness of this rare tumor by anyone dealing with hand pathology can hasten diagnosis, and this, in turn, can potentially increase survival. Therefore, a high index of suspicion for this disease should be kept in mind, particularly when evaluating young people, as they are the most commonly affected group.