Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013.

AIMS: Overweight and obesity are clinical public-health concerns worldwide. Amongst older adults, the prevalence of overweight and obesity is considered high. The purpose of this study was to provide current data regarding the prevalence and trends of overweight and obesity of adults from 2005 to 2013 in 10 European countries. METHODS: The data used in the present study were derived from the first, second, fourth and fifth waves of the Survey of Health, Ageing and Retirement in Europe. The present study includes individuals aged ⩾50 years from 10 European countries. Body mass index (BMI) was calculated from self-reported height and weight (kg/m2). RESULTS: The general prevalence of overweight (BMI ⩾25 kg/m2) was slightly above 60% and remained stable between 2005 (60.1%, 95% confidence interval (CI): 59.3-60.9%) and 2013 (60.3%, 95% CI: 59.7-60.9%). On the other hand, the prevalence of obesity (BMI ⩾30 kg/m2) increased significantly (1.6 points, 95% CI: 0.7-2.6) from 17.5% in 2005 to 19.2% in 2013. Although the prevalence of obesity increased in most countries, the only significant increase was observed in Germany (5.8 points, 95% CI: 1.8-9.9). Spain was the only country where the prevalence of obesity decreased significantly (-4.7 points, 95% CI: -8.8 to -0.5). Sex and age differences are reported. CONCLUSIONS: Although the prevalence of overweight was stable, the prevalence of obesity rose. Based on the data currently available for Europe, the prevalence of obesity in European older adults has already reached epidemic proportions, which reinforces the need for the development of effective healthy lifestyle programs.

The Impact of Non-Physical Education Teachers' Perceptions on the Promotion of Active and Healthy Lifestyles: A Cross-Sectional Qualitative Study.

(1) Background: In accordance with the socio-ecological model of physical education (PE), school-based interventions to promote physical activity (PA) will only be successful if a change occurs in the perceptions and attitudes of all. This study sought to analyze non-PE teachers experiences in PE and how these experiences relate to the value they attribute to PE, sports and PA, and the impact of teachers' perceptions on promoting active lifestyles in the school's context. A mixed-method study was adopted. (2) Methods: A survey about the perceptions in PE was applied to 297 teachers (58 male). From this sample, 24 teachers were selected for three focus groups considering their experiences in PE (e.g., good experiences, bad experiences). MaxQda was used for the inductive qualitative data analysis. (3) Results: Teachers who have had good experiences in PE value the role of PE and sports. Teachers who have had bad experiences do not value the importance of PE or sports. (4) Conclusions: The results support the importance of having good experiences in PE to generate positive attitudes. Thus, teachers who have had bad experiences in PE may constitute barriers that will hinder the promotion of an educational climate that promotes PA and active lifestyles in schools.

Pathological and Epidemiological Characterization of First Outbreak of Daylily Rust in Europe and Evaluation of Puccinia hemerocallidis Resistance in Hemerocallis Cultivars.

Daylily rust-caused by Puccinia hemerocallidis-was confined to Eastern Asia until the disease was reported in Oceania, Africa, the Americas and Portugal in the 21st century. Although information on rust resistance of American cultivars is available, little is known about the resistance of European bred cultivars, threating the ornamental sector if the fungus spreads to other European countries. Aiming to provide tools to address this, we analyzed the Portuguese pathogens and characterized rust resistance in a selection of cultivars, while optimizing disease rating scales. Morphologic, genetic and cytogenomic characterization of four isolates reveals narrow diversity and raises the question whether the pathogen may have originated in North- or Central America. Daily records of multiple symptomatologic parameters enabled a detailed disease progress analysis, discriminating cultivars according to their resistance levels and revealing susceptibility as the most common state. Among the tested cultivars, 12 out of 17 began to show symptoms between 6-8 dai and were classified as susceptible. Cultivars 'Stella d'Oro', 'Bitsy' and 'Cherry Tiger' behaved as moderately resistant although the occurrence of late sporulation on leaves suggests incomplete resistance and challenges common rating scales. The identification of resistance sources in European breeding lines is crucial for the sustainable future of daylilies.

[Cubital artery aneurysm and hypothenar hammer syndrome. Report of an unusual case]. / Aneurisma da artéria cubital e síndrome do martelo hipotenar. Considerações sobre um caso clínico pouco frequente.

Hypothenar hammer syndrome (HHS) is a rare condition and is a term used to described an aneurysm or thrombosis of the ulnar artery. It is considered an occupational or recreational injury and usually results of repetitive trauma to the hypothenar region, where th unique anatomy after the artery leaves the Guyon canal, allows the arterial injury. Clinical manifestations are more often unilateral, involving the dominant hand. However, some authors report the existence of a previous arteriopathy, predisposing to the injury, after repetitive palmar trauma.The authors report the clinical case of a 60 year-old woman, with an ulnar aneurysm in the non dominant hand, without evident existence of repetitive trauma. The pathological examination of the artery revealed muscular hyperplasia, without the characteristics of muscular fibrodysplasia. The authors believe that this case, once again, demonstrates the existence of an autonomous and "previous" arteriopathy associated to the traumatic lesion.

OC46 - NIDCAP at hospital São João - the journey.

Theme: Complex health care and chronic disease management.

OC45 - Towards family-centred care in neonatal intensive care unit.

Theme: Complex health care and chronic disease management.

Socio-demographic correlates of leisure time physical activity among Portuguese adults.

This study aimed to identify socio-demographic correlates of leisure time physical activity among Portuguese adults. Subjects aged 31-60 years (1,076 males, 1,383 females) were categorized into two groups according to recommended physical activities ranging from ≥ 10 or < 10 MET.hours.week-1. Leisure time physical activity data was self-reported, including activities, duration of each session and frequency. Chi-square and logistic regression analyses were applied to the results. Among men, having a high socioeconomic status (OR = 1.89; 95%CI: 1.30-2.76; p = 0.001) was associated with attaining the recommended level of physical activity. For women, middle education levels were associated with physical activity (OR = 1.36; 95%CI: 1.01-1.85). Moreover, middle socioeconomic status (OR = 1.45; 95%CI: 0.80-1.91; p = 0.009) was also positively associated with meeting physical activities recommendations in the unadjusted analysis. Men and women had different patterns of socio-demographic correlates. An intervention designed to improve the levels of physical activity among Portuguese adults may take these correlates into account.

Perception and reality - Portuguese adults' awareness of active lifestyle.

This study aims to assess awareness of physical activity levels among adults and to investigate the variables associated with different types of awareness. The participants were 1042 men and 1316 women aged 31-60 years old (43.3 ± 6.1). Data were collected on physical activity behaviour, physical activity awareness, perceptions and psychological factors. Awareness was assessed by comparing self-rated physical activity with achieving physical activity guidelines. Chi-square and logistic regression analyses were applied to the results. About 32.4% were considered active. Moreover, 61% accurately reported their physical activity (38.3% realistic inactive and 22.7% realistic active), 29.2% overestimated their physical activity (overestimators) and 9.7% incorrectly described themselves as inactive (underestimators). Perception of an excellent health status (odds ratio, OR = 4.07, 95% confidence interval, CI: 2.07-8.00, p < 0.001) was the strongest positive association with being realistic active, followed by having a high socio-economic status (SES) (OR = 1.53, 95% CI: 1.10-2.12, p < 0.05). Overestimator participants were more likely to have an excellent perception of health (OR = 2.58, 95% CI: 1.47-4.52, p < 0.01) and had a good experience in physical education (OR = 1.46, 95% CI:1.03-2.08, p < 0.05). Almost half of these participants erroneously perceived themselves as physically active. Gender, body mass index (BMI) and the quality of physical education at school were associated with those who misperceived their physical activity.

The correlates of meeting physical activity recommendations: a population-based cross-sectional study.

The aim of this study was to identify correlated factors which explain the recommended level of leisure time physical activity (LTPA) among Portuguese adults. Subjects aged 31-60 years (972 males, 1195 females) were categorized, based on LTPA data obtained using a questionnaire, into two groups according to the PA recommendation for PA: ≥ 10 or < 10 MET · hr · wk(-1). Chi-square and logistic regression analyses were applied to the results. For men, the perception of an active lifestyle [odds ratio (OR) = 4.61, 95% CI:3.13-6.81, p <0.001], having an excellent perception of health (OR = 3.14, 95% CI:1.28-7.71, p =0.013), perception of being sufficiently active (OR = 2.16, 95% CI:1.53-3.05, p <0.001), and having a high socio-economic status (SES) (OR = 1.86, 95% CI:1.22-2.81, p =0.004) were associated with attaining the recommended level of PA. For women, the perception of an active lifestyle (OR = 3.68, 95% CI:2.63-5.15, p <0.001), and middle SES (OR = 1.50, 95% CI:1.07-2.11, p =0.018) were positive and associated with meeting PA recommendations. Unlike men, women with body mass index (BMI) 25-29.9 kg/m(2) were more likely to attain the recommended level of PA than those with BMI <25 kg/m(2). The incidence of adults that met the recommended amount of PA is low. Men and women had different patterns of psychological and socio-demographic correlates. An intervention designed to improve the levels of PA among Portuguese adults may take these correlates into account.

Metadherin expression and lung relapse in patients with colorectal carcinoma.

Colorectal cancer (CRC) is the third most common malignant disease in men and the second in women worldwide. CRC relapse occurs mostly in liver and lungs, decreasing the 5-year survival to 6 %. Metadherin (MTDH) is overexpressed in several types of cancer, has been implicated in proliferation, invasion, metastasis, angiogenesis, and chemoresistance, and is a factor of poor prognosis in CRC. In this work we addressed the prognostic significance of MTDH expression in CRC progression to the lungs. We found that MTDH gene was more frequently amplified (copy number >1.8) in patients with CRC and relapse to the lung, when compared to patients without lung metastases (17.4 vs 100 %; p < 0.001). We observed a correlation between MTDH gene copy number and MTDH expression by IHC (p = 0.0001). Next we also analyzed MTDH expression by IHC in samples from 85 patients diagnosed with CRC, stage II or III, M0, with at least 3 years of follow-up. Kaplan-Meier survival analysis showed that lung relapse-free survival (HR 5.29, 95 % CI 1.90-14.77, p = 0.0004), liver relapse-free survival (HR 8.59, 95 % CI 0.99-74.18, p = 0.003), relapse-free survival (HR 4.85, 95 % CI 1.88-12.45, p = 0.0003) and overall survival (HR 3.75, 95 % CI 1.15-12.18, p = 0.018) were significantly lower in the group with high MTDH expression. Multivariate analysis showed that high MTDH expression was an independent factor for all outcomes. This study demonstrates that high MTDH expression is a biomarker of relapse in CRC, including lung-specific relapse. Determination of MTDH expression in primary CRC may be useful in the earlier detection of lung metastases in patients with high expression and increased risk.

A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service.

Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed 'remote' triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients.

Prognostic significance of AKT/mTOR signaling in advanced neuroendocrine tumors treated with somatostatin analogs.

INTRODUCTION: Somatostatin analogs (SSAs) are used as part of standard treatment for advanced neuroendocrine tumors (NETs). The mechanisms behind the antiproliferative action of SSAs remain largely unknown, but a connection with the mammalian target of rapamycin (mTOR) signaling pathway has been suggested. Our purpose was to evaluate the activation status of the AKT/mTOR pathway in advanced metastatic NETs and identify biomarkers of response to SSA therapy. PATIENTS AND METHODS: Expression of phosphatase and tensin homolog (PTEN), phosphorylated (p)-AKT(Ser473), and p-S6(Ser240/244) was evaluated using immunohistochemistry in archival paraffin samples from 23 patients. Expression levels were correlated with clinicopathological parameters and progression-free survival under treatment with SSAs. RESULTS: A positive association between p-AKT and p-S6 expression was identified (P = 0.01) and higher expression of both markers was observed in pancreatic NETs. AKT/mTOR activation was observed without the loss of PTEN expression. Tumors showing AKT/mTOR signaling activation progressed faster when treated with SSAs: higher expression of p-AKT or p-S6 predicted a median progression-free survival of 1 month vs 26.5 months for lower expression (P = 0.02). CONCLUSION: Constitutive activation of the AKT/mTOR pathway was associated with shorter time-to-progression in patients undergoing treatment with SSAs. Larger case series are needed to validate whether p-AKT(Ser473) and p-S6(Ser240/244) can be used as prognostic markers of response to therapy with SSAs.

[Stress and satisfaction of mothers in neonatal intensive care]. / Stress e satisfação das mães em cuidados intensivos neonatais.

INTRODUCTION: The admission and stay in a Neonatal Intensive Care Unit represents an anxious experience to parents, because of their frustrated expectations and the confrontation with the possibility of newborn's death. The aims of this study were to assess how mothers cope with physical characteristics of the context, with treatments and with the loss of the idealized parental role; to assess how mothers evaluate the medical and nurse staff performance; and to assess the degree of satisfaction with the Service. MATERIAL AND METHODS: A sample of 100 mothers, whose newborns were admitted at the Neonatal Intensive Care Unit,was asked to fulfil a specific survey. RESULTS: In a general way, according to the mean of all stress subscales, the total experienced stress was moderate. Significant associations or differences between scholarity and stress were not found, as well as with mother's age. The loss of parental role was the most anxious factor for mothers. The satisfaction with medical team was inversely related to stress. Mothers were satisfied with nurse team performance. CONCLUSION: The loss of the idealized parental role is the most anxious experience for the mothers. The observed results highlight the need for the continuous change of the neonatal unit in a more warming environment for the mothers and their newborns.

Socio-demographic correlates of leisure time physical activity among Portuguese adults / Correlatos sociodemográficos da prática de atividade física de portugueses adultos nos momentos de lazer / Factores sociodemográficos de la actividad física en el tiempo de ocio de los adultos portugueses

This study aimed to identify socio-demographic correlates of leisure time physical activity among Portuguese adults. Subjects aged 31-60 years (1,076 males, 1,383 females) were categorized into two groups according to recommended physical activities ranging from ≥ 10 or < 10 MET.hours.week-1. Leisure time physical activity data was self-reported, including activities, duration of each session and frequency. Chi-square and logistic regression analyses were applied to the results. Among men, having a high socioeconomic status (OR = 1.89; 95%CI: 1.30-2.76; p = 0.001) was associated with attaining the recommended level of physical activity. For women, middle education levels were associated with physical activity (OR = 1.36; 95%CI: 1.01-1.85). Moreover, middle socioeconomic status (OR = 1.45; 95%CI: 0.80-1.91; p = 0.009) was also positively associated with meeting physical activities recommendations in the unadjusted analysis. Men and women had different patterns of socio-demographic correlates. An intervention designed to improve the levels of physical activity among Portuguese adults may take these correlates into account.

O objetivo do estudo foi identificar os correlatos sociodemográficos associados à atividade física dos adultos portugueses nos momentos de lazer. Sujeitos com idades entre os 31-60 anos (1.076 homens, 1.383 mulheres) foram categorizados como fisicamente ativos ou pouco ativos, de acordo com as recomendações da atividade física (≥ 10 MET.horas/semana ou < 10 MET.horas/semana). A atividade física foi autorreportada. O teste do qui-quadrado e regressões logísticas foram aplicados aos dados. Para os homens, um estatuto socioeconômico elevado estava associado ao cumprimento das recomendações da atividade física (OR = 1,89; IC95%: 1,30-2,76; p = 0,001). Para as mulheres, o nível educacional médio (OR = 1,36; IC95%: 1,01-1,85) e um estatuto socioeconômico médio (OR = 1,45; IC95%: 0,80-1,91; p = 0,009) estavam associados a cumprir as recomendações da atividade física. Homens e mulheres apresentaram diferentes correlatos associados à prática de atividade física. Intervenções com o objetivo de melhorar os níveis de atividade física devem considerar os diferentes correlatos identificados.

Este estudio tuvo como objetivo identificar los correlatos sociodemográficos de la actividad física, realizada durante el tiempo libre, en adultos portugueses. Los participantes con edades entre 31 y 60 años (1.079 hombres, 1.383 mujeres) fueron categorizados en dos grupos, de acuerdo con las recomendaciones de actividad física (≥ 10 MET.horas/semana ou < 10 MET.horas/semana). La actividad física fue auto-reportada. Se ha aplicado el análisis de regresión logística y el chi- cuadrado. Los hombres que tienen un alto estatus socioeconómico (OR = 1,89; IC95%: 1,30-2,76; p = 0,001) se asociaron con la consecución del nivel recomendado de actividad física. Para las mujeres, el nivel de educación medio (OR = 1,36; IC95%: 1,01-1,85) y el estado socioeconómico medio (OR = 1,45; IC95%: 0,80-1,91; p = 0,009) se asoció con la actividad física. Hombres y mujeres tienen diferentes patrones de correlatos sociodemográficos. Una intervención diseñada para mejorar los niveles de actividade física entre los adultos portugueses podrá adoptar dichas correlaciones en cuenta.

Padrões de casamento dos imigrantes brasileiros residentes em Portugal / Patrones de matrimonio de los inmigrantes brasileños residentes en Portugal / /Marriage patterns of Brazilian immigrants living in Portugal

Ao longo das últimas décadas, o número de estrangeiros residentes em Portugal aumentou de forma expressiva. Neste contexto, a comunidade brasileira assumiu uma importância cada vez maior, sendo em 2009 a nacionalidade mais representada, com uma participação de 25% no total de residentes estrangeiros em Portugal. Esta evolução tem, como seria de se esperar, reflexos a outros níveis, em particular no contexto do casamento. Contrariando a tendência decrescente observada para o total de casamentos ocorridos entre 2001 e 2009, aqueles em que pelo menos um dos cônjuges nasceu no Brasil quase quadruplicaram nesse período. Para muitos autores, os casamentos mistos são um bom indicador da integração das comunidades imigrantes na sociedade de acolhimento. Assim, dada a importância da comunidade brasileira residente em Portugal, é relevante observar qual o peso dos casamentos mistos nesta comunidade e analisar seus padrões de matrimônio. A análise estatística dos microdados dos casamentos disponibilizados pelo Instituto Nacional de Estatística possibilitou estudar e caraterizar a evolução dos casamentos registrados em Portugal, entre 2001 e 2009, envolvendo brasileiros residentes em Portugal. Ficou patente a existência de um elevado nível de casamentos mistos, em especial com portugueses, neste período, o que indicia sua integração na comunidade de acolhimento. Verificaram-se igualmente algumas diferenças nos padrões de matrimônio entre os sexos, bem como uma tendência para a diminuição da importância dos casamentos mistos, em especial entre os homens.

A lo largo de las últimas décadas, el número de extranjeros residentes en Portugal aumentó de forma expresiva. En este contexto, la comunidad brasileña asumió una importancia cada vez mayor, siendo en 2009 la nacionalidad más representativa, con una cuota de residentes del 25% en el total de población extranjera en Portugal. Esta evolución tiene, como cabría esperar, reflejos en otros niveles, en particular en el contexto del matrimonio. Contrariando la tendencia decreciente, observada para el total de matrimonios producidos entre 2001 y 2009, aquellos en que por lo menos uno de los cónyuges nació en Brasil casi se cuadruplicaron en ese período. Para muchos autores, los matrimonios mixtos son un buen indicador de la integración de las comunidades inmigrantes en la sociedad de acogida. Así pues, dada la importancia de la comunidad brasileña residente en Portugal, es relevante observar cuál es el peso de los matrimonios mixtos en esta comunidad y analizar sus patrones de matrimonio. El análisis estadístico de los microdatos de los matrimonios, puestos a nuestra disposición por el Instituto Nacional de Estadística, posibilitó estudiar y caracterizar la evolución de los matrimonios registrados en Portugal, entre 2001 y 2009, involucrando a brasileños residentes en Portugal. Quedó patente la existencia de un elevado nivel de matrimonios mixtos, en especial con portugueses, durante este período, lo que indicia su integración en la comunidad de acogida. Se verificaron igualmente algunas diferencias en los patrones de matrimonio entre los sexos, así como una tendencia a la disminución de la importancia de los matrimonios mixtos, en especial entre los hombres.

Over the past decades, the number of foreign residents in Portugal has increased significantly. In this context, the Brazilian community is of increasing importance, and was, in 2009, the most represented nationality, with a 25% share in the total of foreign residents in Portugal. As expected, this development reflects on other levels, particularly in the context of marriage. Contrary to the downward trend observed for total marriages occurring between 2001 and 2009, those in which at least one spouse was born in Brazil almost quadrupled during the period. For many authors, mixed marriages are a good indicator of immigrant community integration in the host society. Thus, given the prominence of the Brazilian community in Portugal, it is important to observe the relevance of mixed marriages in this community and to analyze marriage patterns. Statistical analysis of microdata from weddings provided by the National Statistics Institute led us to study and characterize the possible evolution of marriages registered in Portugal between 2001 and 2009 and involving Brazilians living in Portugal. During this period there was a high number of mixed marriages, especially with Portuguese nationals, suggesting an integration with the host community. There were also some differences in the patterns of marriage between the sexes, as well as a tendency to a decreasing importance of mixed marriages, especially among men.