Health care expenses impact on the disability-adjusted life years in non-communicable diseases in the European Union.

Background: Non-communicable diseases are a global health problem. The metric Disability-Adjusted Life Years was developed to measure its impact on health systems. This metric makes it possible to understand a disease's burden, towards defining healthcare policies. This research analysed the effect of healthcare expenditures in the evolution of disability-adjusted life years for non-communicable diseases in the European Union between 2000 and 2019. Methods: Data were collected for all 27 European Union countries from Global Burden of Disease 2019, Global Health Expenditure, and EUROSTAT databases. Econometric panel data models were used to assess the impact of healthcare expenses on the disability-adjusted life years. Only models with a coefficient of determination equal to or higher than 10% were analysed. Results: There was a decrease in the non-communicable diseases with the highest disability-adjusted life years: cardiovascular diseases (-2,952 years/105 inhabitants) and neoplasms (-618 years/105 inhabitants). Health expenditure significantly decreased disability-adjusted life years for all analysed diseases (p < 0.01) unless for musculoskeletal disorders. Private health expenditure did not show a significant effect on neurological and musculoskeletal disorders (p > 0.05) whereas public health expenditure did not significantly influence skin and subcutaneous diseases (p > 0.05). Conclusion: Health expenditure have proved to be effective in the reduction of several diseases. However, some categories such as musculoskeletal and mental disorders must be a priority for health policies in the future since, despite their low mortality, they can present high morbidity and disability.

Physical education teachers' knowledge of physical activity recommendations for health promotion in children and adolescents.

This study aimed to analyse the knowledge of Portuguese physical education (PE) teachers according to the health recommendations for physical activity (PA) for children and adolescents. A total of 764 teachers participated (55.2% men) with a mean age of 48.2 years. Data was collected using answering to an online survey. Teachers were asked about PA's frequency, duration and intensity to achieve the recommended level PA. Chi-square was applied to analyse the associations. The main finding is that PE teachers have a lack of knowledge of the health recommendations of PA. Specifically, only 7.5% of the PE teachers in our study could identify the PA recommendations correctly. The intensity component in the health recommendation is the one in which most PE teachers demonstrate correct knowledge of (60.5%), with significant differences in gender and teaching level. However, significantly fewer PE teachers knew the frequency component in the health recommendations for PA (25%), with significant differences in education level. For the duration component, only 37.6% of teachers knew the recommendations. In light of our findings, it is a concern that PE teachers generally lack knowledge according to children's fulfilment of health recommendations for PA.

Assessment of energy sharing coefficients under the new Portuguese renewable energy communities regulation.

The recent published European legal framework (Directives (EU) 2018/2001 and 2019/944) on renewable energy consumption, and its Portuguese transposition (the Decree-Law 15/2022), opens the possibility for buildings to operate as energy communities. One of the objectives is to increase the use of locally generated energy from renewable sources, by sharing available surplus among participants, using sharing coefficients defined by the entire community. Taking the actual legal framework into consideration, this paper presents an analysis of the energy sharing coefficients proposed by the newly published Portuguese legislation via the assessment of a renewable energy community, formed by public buildings, whose operation varies according to different sharing coefficient applied. Results show that time-variable energy sharing coefficients are the best option to the considered renewable energy community. Collected results also show that larger consumers can extract higher benefits from being integrated on a renewable energy community. These benefits decrease when buildings are allowed to self-consume local generated energy prior to the sharing process as demand inequalities become less important for the computation of the considered sharing coefficients. The entire community also presents better performance in this case.

Cost-effectiveness analysis of full versus selective root canal retreatment.

AIM: Selective root-canal retreatment has been proposed as an alternative to full retreatment in multirooted, root-canal-filled teeth with evidence of apical pathology, where only the affected root(s) is retreated. Whilst this option may save costs initially, failures and retreatments may compensate for these initial savings. We assessed the cost-effectiveness of full versus selective root-canal retreatment using data from a recent clinical pilot study, employing a modelling approach. METHODOLOGY: A Markov model was constructed to follow up a previously root-canal treated maxillary molar with apical pathology on a single root (mesio-buccal), receiving either selective or full root-canal retreatment. A private-payer perspective in Dutch health care was adopted. Permanent molar teeth with apical lesions on the mesial root were simulated over the lifetime of initially 50-year-old patients. Teeth could have endodontic complications and require interventions such as retreatment or tooth extraction and replacement. Costs were calculated based on the Dutch dental fee catalogues. Monte-Carlo microsimulations were performed to assess lifetime costs and effectiveness (measured as tooth retention time), and the resulting cost-effectiveness. Probabilistic joint uncertainty and sensitivity analyses were performed, and cost-effectiveness at different willingness-to-pay-thresholds was evaluated. RESULTS: In the base-case scenario, selective retreatment was less costly (2137; 2.5%-97.5% percentiles: 1944-2340 Euro) and more effective (19.6; 18.3-20.8 Years) than full retreatment (2495; 2305-2671 Euro; 16.5; 15.2-17.9 Years) in 100% of the simulations and regardless of the willingness-to-pay threshold. Only in a worst case scenario was selective retreatment more costly, but remained more effective. CONCLUSIONS: Selective retreatment, when clinically applicable, is likely to be more cost-effective than full retreatment in endodontically treated molars with persistent apical periodontitis. Our results should be interpreted with caution because the quality of the underlying data is limited.

Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries.

Importance: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective: To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Design, Setting, and Participants: Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Exposures: Countries' per capita income levels and world region; individuals' socioeconomic demographics. Main Outcomes and Measures: Self-reported use of aspirin for secondary prevention of CVD. Results: The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Conclusion and Relevance: Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.

Assessment of the Prevalence of Radix Entomolaris and Distolingual Canal in Mandibular First Molars in 15 Countries: A Multinational Cross-sectional Study with Meta-analysis.

AIM: The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. METHODS: CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. RESULTS: Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P < .05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%-29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%-5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P > .05). CONCLUSION: The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.

Portuguese Physical Literacy Assessment for adolescents (15-18 years): validation using confirmatory factor and composite analyses.

Objective: The aim of this study was to assess the construct validity and reliability of the Portuguese Physical Literacy Assessment (PPLA) instruments (a questionnaire and a tool using teacher-reported data). We also investigated the conceptual and practical implications of reflective vs. formative measurement of Physical Literacy using the PPLA. Methods: Multiple Confirmatory Factor Analysis (CFA) and Confirmatory Composite Analysis (CCA) models were used complementarily to assess construct validity in a sample of 521 grade 10-12 Portuguese students from Lisbon, Portugal. Bifactor model-based indices (ω), Explained Common Variance (ECV), and Percentage of Uncontaminated Correlations (PUC) were used to assess score reliability and adequacy. Results: Using CFA, an asymmetrical bifactor model (S*1-1) provided the best fit to the data [Robust Comparative Fit Index = 97, Robust Root Mean Square Error Of Approximation = 0.05 (0.04-0.06), Standardized Root Mean Square Residual (SRMR) = 0.04], while CCA resulted in the best absolute fit for single first-order composite models (dG, dL, and SRMR below or borderline of their 95% critical value). Through a reflective paradigm, the total PL score should not be used in isolation (ECV = 0.49, ωH = 0.71, lower than recommended 0.80). Subscales for the Physical, Psychological, and Social domains attained acceptable reliability scores (ωs = 0.76, 0.82, 0.80, and 0.60). Conclusions: A general trait of PL accounts for considerable variance in all indicators. We advise calculation of a total summed PL score and domain scores, which should be interpreted conjointly in applied settings. Despite both paradigms being tenable, future research efforts should use a bifactor measurement model, which permits disentanglement of the variance attributed to the general PL trait and its domains. Overall, evidence supported the construct validity and reliability of the PPLA for its intended use as an integrated tool to measure PL as a multidimensional construct in 15- to 18-year-old Portuguese students in a physical education setting.

In Vitro Characterization and Real-Time Label-Free Assessment of the Interaction of Chitosan-Coated Niosomes with Intestinal Cellular Monolayers.

In vitro cell-based characterization methods of nanoparticles are generally static and require the use of secondary analysis techniques and labeling agents. In this study, bare niosomes and chitosan-coated niosomes (chitosomes) and their interactions with intestinal cells are studied under dynamic conditions and without fluorescent probes, using surface plasmon resonance (SPR)-based cell sensing. Niosomes and chitosomes were synthesized by using Tween 20 and cholesterol in a 15 mM:15 mM ratio and then characterized by dynamic light scattering (DLS). DLS analysis demonstrated that bare niosomes had average sizes of ∼125 nm, polydispersity index (PDI) below 0.2, and a negative zeta (ζ)-potential of -35.6 mV. In turn, chitosomes had increased sizes up to ∼180 nm, with a PDI of 0.2-0.3 and a highly positive ζ-potential of +57.9 mV. The viability of HT29-MTX, Caco-2, and Caco-2/HT29-MTX cocultured cells showed that both niosomes and chitosomes are cytocompatible up to concentrations of 31.6 µg/mL for at least 240 min. SPR analysis demonstrated that chitosomes interact more efficiently with HT29-MTX, Caco-2, and Caco-2/HT29-MTX cocultures compared to bare niosomes. The resulting SPR measurements were further supported by confocal microscopy and flow cytometry studies, which demonstrated that this method is a useful complementary or even alternative tool to directly characterize the interactions between niosomes and in vitro cell models in label-free and real-time conditions.

Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q) for Adolescents: Validity and Reliability of the Psychological and Social Modules using Mokken Scale Analysis.

We examined the construct validity and reliability of the previously developed Psychological and Social modules of the Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q) using Mokken Scale Analysis in a sample of 508 Portuguese adolescents in public schools in Lisbon. We used a retest subsample (n = 73) to calculate the Intraclass Correlation Coefficient. Eight PPLA-Q scales can be interpreted as moderate-to-strong Mokken scales (H = .47-.66) with good total-score reliability (ρ = .83-.94), and moderate-to-excellent test-retest reliability (ICC95%CI = .51-.95); four scales had an interpretable invariant item ordering. All but the Physical Regulation scale functioned similarly across sex. Scale-scores correlated as expected, with low-to-moderate correlations across domains supporting convergent and discriminant validity. These results support the construct validity and reliability of the PPLA-Q to assess the psychological and social domains of physical literacy in Portuguese adolescents (15-18 years) enrolled in physical education.

Assessment of the Prevalence of Middle Mesial Canal in Mandibular First Molar: A Multinational Cross-sectional Study with Meta-analysis.

BACKGROUND: An additional canal found in the mandibular first molar (M1M) is the middle mesial canal (MMC), which is often missed during root canal treatment. In this study, the prevalence of MMC in M1M on cone-beam computed tomography (CBCT) images was evaluated in 15 countries, along with the effect of some demographic factors on its prevalence. METHODS: Deidentified CBCT images were scanned retrospectively, and the ones including bilateral M1Ms were included in the study. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating three planes (coronal, sagittal, and axial) after a 3-dimensional alignment of the long axis of the root(s). The presence of an MMC in M1Ms (yes/no) was identified and recorded. RESULTS: In total, 6304 CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries (P < .05). MMC prevalence ranged from 1% to 23%, and the overall prevalence was 7% (95% confidence interval [CI]: 5%-9%). No significant differences were found between the left and right M1M (odds ratio = 1.09, 95% CI: 0.93, 1.27; P > .05) or between genders (odds ratio= 1.07, 95% CI: 0.91, 1.27; P > .05). As for the age groups, no significant differences were found (P > .05). CONCLUSIONS: The prevalence of MMC varies by ethnicity, but it is generally estimated at 7% worldwide. Physicians must pay close attention to the presence of MMC in M1M, especially for opposite M1Ms, due to the prevalence of MMC being significantly bilateral.

Demand for emergency services during the COVID-19 pandemic and disease burden: a case study in Portugal.

Background: The COVID-19 pandemic brought changes in the pattern of care use. A significant increase in the volume of emergencies was expected. However, a significant decrease was observed worldwide. Methods: An observational, analytical and cross-sectional study of all records of emergency episodes of patients aged 18 years or older admitted to the emergency services of the University of Porto Hospital Centre (2018-2022) were analysed. Results: During the pandemic, a significant reduction in emergency episode admissions (up to 40% during lockdowns), an increase in pre-emergency services, and discharges from Infectious Diseases and Internal Medicine was observed. The discharges from General Practice and General Practice and Family Medicine were residual. Conclusion: The lower use and type of use of emergency services during the COVID-19 pandemic had a negative impact on the disease burden. This could be prevented in future pandemics through the development of strategies to promote confidence in the use of health resources and establishing contingency plans for virtual assistance.

Portuguese Physical Literacy Assessment - Observation (PPLA-O) for adolescents (15-18 years) from grades 10-12: Development and initial validation through item response theory.

Introduction: Aims of these studies were to develop the Portuguese Physical Literacy Assessment Observation instrument (PPLA-O) to assess the physical and part of the cognitive domain of Physical Literacy (PL) through data collected routinely by Physical Education (PE) teachers; and to assess the construct validity (dimensionality, measurement invariance, and convergent and discriminant validity) and score reliability of one of its modules [Movement Competence, Rules, and Tactics (MCRT)]. Methods: Content analysis of the Portuguese PE syllabus and literature review were used for PPLA-O domain identification. Multidimensional Item Response Theory (MIRT) models were used to assess construct validity and reliability, along with bivariate correlations in a sample of 515 Portuguese grade 10-12 students (M age = 16, SD = 1). Results: PPLA-O development resulted in an instrument with two modules: MCRT (22 physical activities) and Health-Related Fitness (HRF; 5 protocols); both assessed with teacher-reported data entered in a spreadsheet. A two correlated dimensions Graded Response Model (Manipulative-based Activities [MA], and Stability-based Activities [SA]) showed best fit to the MCRT data, suggesting measurement invariance across sexes, and adequate to good score reliabilities (MA = .89, and SA = .73). There was a moderate to high correlation (r = .68) between dimensions, and boys had higher scores in both dimensions. Correlations among MCRT scores and HRF variables were similar in magnitude to previous reports in meta-analysis and systematic reviews. Conclusions: PPLA-O is composed of two modules that integrate observational data collected by PE teachers into a common frame of criterion-referenced PL assessment. The HRF module uses data collected through widely validated FITescola® assessment protocols. The MCRT makes use of teacher-reported data collected in a wide range of activities and movement pursuits to measure movement competence and inherent cognitive skills (Tactics and Rules). We also gathered initial evidence supporting construct validity and score reliability of the MCRT module. This highly feasible instrument can provide Portuguese grade 10-12 (15-18 years) PE students with feedback on their PL journey, along with the other instrument of PPLA (PPLA-Questionnaire). Further studies should assess inter and intra-rater reliability and criterion-related validity of its two modules.

Influence of energy drinks on enamel erosion: In vitro study using different assessment techniques.

BACKGROUND: Dental erosion has become a relevant public health problem in recent years and is related to the increase in the consumption of acidic beverages. Objective: The aim of the present study was to evaluate the erosive potential of energy drinks on dental enamel using an in vitro erosion model. MATERIAL AND METHODS: Thirty-eight blocks of human enamel were divided into four groups: G1- TNT Energy Drink®(n=8), G2- Red Bull® (n=10), G3- Monster Energy® (n=10), and G4- Coca-Cola® (n=10) (positive control). For the chemical analysis, the pH values, titratable acidity, and buffering capacity of the beverages were measured in triplicate. For the erosive test, the specimens were immersed in the beverages (5ml/block) for 30 minutes at room temperature with gentle shaking. Initial and final surface microhardness values were measured and the percentage of the loss of surface microhardness was calculated. Profilometry (surface loss and lesion depth) and mineral loss analysis (quantitative light-induced fluorescence) were performed. The data were analysed statistically using ANOVA followed by the Bonferroni correction, Pearson's correlation test, and multiple linear regression (p<0.05). RESULTS: The energy drinks had pH values ranging from 2.36 to 3.41. The lowest titratable acidity value was recorded for Monster Energy® and the highest was recorded for TNT Energy Drink®. All energy drinks had buffering capacity values higher than Coca-Cola®. Analysing the eroded enamel surface, the specimens submitted to TNT Energy Drink® had the greatest percentage loss of surface microhardness, surface loss, depth, and mineral loss, followed by those submitted to Red Bull® and Monster Energy®. Surface loss was the only predictor of mineral loss (p<0.001). CONCLUSIONS: Based on the study model employed, all the energy drinks examined were erosive to tooth enamel and TNT Energy Drink® had the worst behaviour. Key words:Energy drinks, tooth erosion, tooth demineralisation, hardness tests, quantitative light-induced fluorescence.

Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q) for adolescents (15-18 years) from grades 10-12: development, content validation and pilot testing.

BACKGROUND: The Portuguese Physical Literacy Assessment (PPLA) is a novel tool to assess high-school students' (grade 10-12; 15-18 years) Physical Literacy (PL) in Physical Education (PE); inspired by the four domains of the Australian Physical Literacy Framework (APLF), and the Portuguese PE syllabus. This paper describes the development, content validation, and pilot testing of the PPLA-Questionnaire (PPLA-Q), one of two instruments in the PPLA, comprised of modules to assess the psychological, social, and part of the cognitive domain of PL. METHODS: Development was supported by previous work, analysis of the APLF, and literature review. We iteratively gathered evidence on content validity through two rounds of qualitative and quantitative expert validation (n = 11); three rounds of cognitive interviews with high-school students (n = 12); and multiple instances of expert advisor input. A pilot study in two grade 10 classes (n = 41) assessed feasibility, preliminary reliability, item difficulty and discrimination. RESULTS: Initial versions of the PPLA-Q gathered evidence in favor of adequate content validity at item level: most items had an Item-Content Validity Index ≥.78 and Cohen's κ ≥ .76. At module-level, S-CVI/Ave and UA were .87/.60, .98/.93 and .96/.84 for the cognitive, psychological, and social modules, respectively. Through the pilot study, we found evidence for feasibility, preliminary subscale and item reliability, difficulty, and discrimination. Items were reviewed through qualitative methods until saturation. Current PPLA-Q consists of 3 modules: cognitive (knowledge test with 10 items), psychological (46 Likert-type items) and social (43 Likert-type items). CONCLUSION: Results of this study provide evidence for content validity, feasibility within PE setting and preliminary reliability of the PPLA-Q as an instrument to assess the psychological, social, and part of the cognitive domain of PL in grade 10 to 12 adolescents. Further validation and development are needed to establish construct validity and reliability, and study PPLA-Q's integration with the PPLA-Observation (an instrument in development to assess the remaining domains of PL) within the PPLA framework.

Nanofat injector: dispositivo descartável de baixo custo para padronização e otimização do tempo de enxertia / Nanofat injector: a low-cost disposable device for standardization and optimization of grafting time

Introdução: O enxerto de gordura nano melhora a qualidade da pele nos danos secundários ao envelhecimento e nas sequelas cicatriciais. Apresentamos resultados iniciais do enxerto de gordura nano com o uso de um dispositivo descartável de baixo custo propondo uma padronização da sua utilização conforme a área a ser tratada. Métodos: Foi realizada uma coorte prospectiva de julho de 2019 a março de 2020. O critério de inclusão foi pacientes que realizaram enxerto de gordura nano para tratamento da pele. Já o critério de exclusão foi a realização prévia de algum tratamento invasivo da pele. Foram analisadas 20 pacientes consecutivas que preencheram os pré-requisitos. Os resultados foram avaliados no 6º mês de pós-operatório. As pacientes responderam um questionário, classificando de 1 - muito ruim a 10 - excelente, as alterações na qualidade da pele. Resultados: As vinte pacientes acompanhadas não apresentaram nenhuma complicação pós-operatória. O edema após aplicação reduziu entre três e sete dias. Não houve hematoma nem infecção. As pacientes que realizaram somente enxerto de gordura nano, sem outra cirurgia associada, conseguiram voltar às suas atividades após 24 horas. Os escores relatados pelas pacientes com 6 meses foram entre 7 e 10, com média de 8. Conclusão: A utilização do sistema Smartneedle™ para a enxertia de gordura nano apresenta resultados na satisfação das pacientes semelhante aos outros métodos de aplicação e permite uma distribuição uniforme e padronizada do enxerto conforme a região anatômica, além de otimizar o tempo cirúrgico.

Introduction: Nanofat graft improves skin quality in damage secondary to aging and scar sequelae. We present the initial results of the nanofat graft using a low-cost disposable device, proposing a standardization of its use according to the area to be treated. Methods: A prospective cohort was conducted from July 2019 to March 2020. The inclusion criterion was patients who underwent nanofat grafting for skin treatment. The exclusion criterion was the previous performance of some invasive treatment of the skin. Twenty consecutive patients who met the prerequisites were analyzed. The results were evaluated in the 6th postoperative month. The patients answered a questionnaire, classifying from 1 - very bad to 10 - excellent, changes in skin quality. Results: The twenty patients followed did not present any postoperative complications. Edema after the application was reduced between three and seven days. There was no hematoma or infection. Patients who underwent only nanofat grafting without another associated surgery could return to their activities after 24 hours. The scores reported by patients at 6 months were between 7 and 10, with a mean of 8. Conclusion: The use of the Smartneedle™ system for nanofat grafting presents patient satisfaction similar to other application methods and allows a uniform and standardized distribution of the graft according to the anatomical region and optimizing surgical time

[Early Detection of COVID-19 in Portugal: Use of Clinical Records]. / Deteção Precoce de COVID-19 em Portugal: Uso de Registos Clínicos.

INTRODUCTION: Syndromic surveillance allows early detection of changes in the population's morbidity pattern. The aim of this study is to evaluate the usefulness of indicators related to access to healthcare services, in COVID-19 surveillance. MATERIAL AND METHODS: A time series analysis was performed using the weekly incidence rate of COVID-19 in Mainland Portugal, between weeks 14/2020 (March 30 to April 5) and 25/2020 (June 15 to 21), and six indicators: 1) COVID-19 consultations in primary healthcare; 2) number of COVID-19 emergency department visits; 3) number of emergency department visits due to viral pneumonia; 4) number of hospitalizations due to viral pneumonia; 5) proportion of emergency department visits due to viral pneumonia; and 6) proportion of hospitalizations for viral pneumonia. Pearson correlation and cross-correlations were computed. RESULTS: A strong correlation was found between the weekly incidence rate of COVID-19 and all indicators. [(1) 0.76; (2) 0.82; (3) 0.77; (4) 0.84; (5) 0.86; e (6) 0.90]. Emergency department visits and hospitalizations for viral pneumonia detect variations in the frequency of the disease with a one week lag compared to the incidence rate of COVID-19, in one week. COVID-19 consultations in primary healthcare and emergency department visits trail behind the incidence rate of COVID-19, in one week. The proportion of viral pneumonias in emergency department visits, or hospitalizations, is temporally aligned with the weekly incidence rate of COVID-19. DISCUSSION: The delay found in the COVID-19 primary healthcare consultations and emergency department visits, may be related to changes in access to healthcare services and clinical coding. Emergency department visits and hospitalizations for viral pneumonia may be useful in the early detection of COVID-19. Viral pneumonia may have been coded as being of unknown origin. Future monitoring of these indicators is necessary to ascertain whether the incidence of COVID-19 is significantly influenced by changes in testing strategies. The indicators described in this study will be an asset for the optimization of testing strategies, allocation of healthcare resources to the communities that are most vulnerable to severe morbidity and assessing vaccination impact. As such, surveillance systems based on clinical data will be a valuable complementary tool to SINAVE. CONCLUSION: The indicators under analysis could be used regularly, with special attention to viral pneumonias, to detect outbreaks of COVID-19. Information on pneumonia of unknown etiology may be considered in the surveillance of COVID-19.

Introdução: A vigilância sindrómica permite a identificação precoce de alterações no padrão de morbilidade da população. Este estudo tem como objetivo avaliar a utilidade de indicadores relativos a cuidados de saúde primários e hospitalares, na vigilância da COVID-19.Material e Métodos: Foi realizada uma análise de séries temporais utilizando a taxa de incidência semanal de COVID-19 em Portugal Continental, entre as semanas 14/2020 (30 março a 05 abril) e 25/2020 (15 a 21 junho), e seis indicadores: 1) consultas em cuidados de saúde primários por COVID-19; 2) número de episódios de urgência por COVID-19; 3) número de episódios de urgência por pneumonia vírica; 4) número de internamentos por pneumonia vírica; 5) proporção de episódios de urgência por pneumonia vírica face ao total de episódios de urgência por pneumonia; e 6) proporção de internamentos por pneumonia vírica face ao total de internamentos por pneumonia. Foram calculadas correlações de Pearson e correlações cruzadas.Resultados: Foi encontrada uma correlação forte entre a taxa de incidência semanal de COVID-19 e todos os indicadores [(1) 0,76; (2) 0,82; (3) 0,77; (4) 0,84; (5) 0,86; e (6) 0,90]. Os episódios de urgência e internamento por pneumonias víricas detetam variações na frequência da doença, com uma semana de antecedência. As consultas em cuidados de saúde primários e urgências por COVID-19 registam uma semana de atraso relativamente à evolução da taxa de incidência. A proporção de pneumonias víricas face ao número de pneumonias em episódios de urgência, ou internamentos, encontra-se alinhada temporalmente com a evolução da taxa de incidência semanal de COVID-19.Discussão: O atraso encontrado no padrão de evolução de consultas em CSP, e de episódios de urgência por COVID-19 face à incidência de COVID-19, poderá estar relacionado com a reorganização dos serviços de saúde e criação de códigos específicos para estas consultas. Episódios de urgência e internamentos por pneumonia vírica poderão ser úteis para a deteção precoce de possíveis surtos de COVID-19. Pneumonias víricas poderão ter sido classificadas como pneumonias de causa indeterminada. A monitorização futura destes indicadores é necessária de modo a averiguar se a incidência de COVID-19 é influenciada significativamente por alterações na estratégia de testagem. Os indicadores deste trabalho serão uma mais valia para a adequação de estratégias de testagem, alocação de recursos de saúde a comunidades mais vulneráveis à morbilidade severa e avaliação de programas de vacinação. Como tal, os sistemas de vigilância com base em registos de saúde serão um complemento valioso ao SINAVE.Conclusão: Sugere-se que os indicadores em análise sejam utilizados de forma regular, com especial atenção à informação relativa a pneumonias víricas, como forma de detetar precocemente surtos de COVID-19. A informação relativa a pneumonias de causa indeterminada poderá ser considerada na monitorização da COVID-19.

Improving pollutants environmental risk assessment using a multi model toxicity determination with in vitro, bacterial, animal and plant model systems: The case of the herbicide alachlor.

Several environmental pollutants, including pesticides, herbicides and persistent organic pollutants play an important role in the development of chronic diseases. However, most studies have examined environmental pollutants toxicity in target organisms or using a specific toxicological test, losing the real effect throughout the ecosystem. In this sense an integrative environmental risk of pollutants assessment, using different model organisms is necessary to predict the real impact in the ecosystem and implications for target and non-target organisms. The objective of this study was to use alachlor, a chloroacetanilide herbicide responsible for chronic toxicity, to understand its impact in target and non-target organisms and at different levels of biological organization by using several model organisms, including membranes of dipalmitoylphosphatidylcholine (DPPC), rat liver mitochondria, bacterial (Bacillus stearothermophilus), plant (Lemna gibba) and mammalian cell lines (HeLa and neuro2a). Our results demonstrated that alachlor strongly interacted with membranes of DPPC and interfered with mitochondrial bioenergetics by reducing the respiratory control ratio and the transmembrane potential. Moreover, alachlor also decreased the growth of B. stearothermophilus and its respiratory activity, as well as decreased the viability of both mammalian cell lines. The values of TC50 increased in the following order: Lemna gibba < neuro2a < HeLa cells < Bacillus stearothermophilus. Together, the results suggest that biological membranes constitute a putative target for the toxic action of this lipophilic herbicide and point out the risks of its dissemination on environment, compromising ecosystem equilibrium and human health.

Socio-demographic factors associated with physical activity and sitting time patterns in adults: An analysis based on the Portuguese Food, Nutrition and Physical Activity Survey.

ABSTRACTPhysical activity (PA) and sedentary behaviours (SB) influence health. Since most people engage in different combinations of both behaviours every day, understanding the socio-demographic characteristics of adults with distinct PA and sitting time (ST) patterns is important to contribute to evidence-based planning of public health strategies. Data from a national survey on diet and activity behaviours (IAN-AF, 2015/16) including 1724 adults (50.5% women, 18-64 years) from a representative sample of Portuguese adults was used in this study. Participants were interviewed face-to-face, and the International Physical Activity Questionnaire (IPAQ) was used. Logistic regression examined the associations between socio-demographic factors each of the four-low/high PA-ST groups. PA low/high categories were defined as in IPAQ, while ST low/high categories were defined according to ST tertiles (≤180 min/day, ≥360 min/day). A 'higher risk' behaviour pattern (low PA/high ST) was present in 37.3% of the adults and was likely associated with a middle household income, and with having 12 or more years of education. The 'lower risk' (high PA/low ST) represented 26.6% of the sample and was likely associated with middle-aged adults and with having a lower educational level. Being male, young and highly educated was related to being physically active and spending large amounts of time in ST. Besides adding to the body of mixed evidence on this theme, the identification of the socio-demographic factors associated with each PA/ST pattern will permit national public health authorities to define policies and tailored actions to promote PA and reduce ST.

Computing and visualising intra-voxel orientation-specific relaxation-diffusion features in the human brain.

Diffusion MRI techniques are used widely to study the characteristics of the human brain connectome in vivo. However, to resolve and characterise white matter (WM) fibres in heterogeneous MRI voxels remains a challenging problem typically approached with signal models that rely on prior information and constraints. We have recently introduced a 5D relaxation-diffusion correlation framework wherein multidimensional diffusion encoding strategies are used to acquire data at multiple echo-times to increase the amount of information encoded into the signal and ease the constraints needed for signal inversion. Nonparametric Monte Carlo inversion of the resulting datasets yields 5D relaxation-diffusion distributions where contributions from different sub-voxel tissue environments are separated with minimal assumptions on their microscopic properties. Here, we build on the 5D correlation approach to derive fibre-specific metrics that can be mapped throughout the imaged brain volume. Distribution components ascribed to fibrous tissues are resolved, and subsequently mapped to a dense mesh of overlapping orientation bins to define a smooth orientation distribution function (ODF). Moreover, relaxation and diffusion measures are correlated to each independent ODF coordinate, thereby allowing the estimation of orientation-specific relaxation rates and diffusivities. The proposed method is tested on a healthy volunteer, where the estimated ODFs were observed to capture major WM tracts, resolve fibre crossings, and, more importantly, inform on the relaxation and diffusion features along with distinct fibre bundles. If combined with fibre-tracking algorithms, the methodology presented in this work has potential for increasing the depth of characterisation of microstructural properties along individual WM pathways.

Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data.

BACKGROUND: Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. METHODS AND FINDINGS: We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08-3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09-4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02-1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06-1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11-1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01-1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12-2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01-1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09-1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01-1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes. CONCLUSION: In this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries' preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care.