The association of adolescents' smoking with the physical activity levels of their friends.

BACKGROUND: Smoking is inversely related to people's Physical Activity Level (PAL). As the behavior of friends may affect the choices and behavior of adolescents, having friends with a high PAL may potentially protect against adolescent smoking. This study aims to assess whether adolescents' smoking is associated with the PAL of their friends. METHODS: SILNE-R survey data of 11.918 adolescents from 55 different schools in 7 European cities was used to determine weekly smoking, individual PAL, PAL of friends, school PAL, and smoking of friends. Multilevel, multivariable logistic regression analysis were used to assess the association between the PAL of friends and weekly smoking. Several socio-demographic variables were included as covariates in the analysis. RESULTS: Our results indicated that 10.8% of the respondents was smoking weekly. Weekly smoking was most common among adolescents whose friends had a PAL of 0-42.0 min per day (14.5%). Respondents were significantly more likely to be smoking weekly if their friends were on average 0-42 min vs. 80-180 min physically active (OR 1.27 [95% CI 1.04-1.55]). This association existed independently of the individual PAL of respondents. Stratification for smoking of friends yielded equal results, although the association appeared to be somewhat stronger for those with smoking friends (OR 1.38 [95% CI 1.06-1.82]). CONCLUSION: Adolescents are less likely to smoke weekly if they associate with friends who spend >80 min per day on physical activity. Initiatives aimed at the prevention of smoking among adolescents may benefit from organizing group-based physical activity programs.

Combining jobs and motherhood: is it worse when raising children alone?

BACKGROUND: Paid employment has been shown to benefit childless women's health, while employed mothers experience poorer health, and more pronounced fatigue. This study measures the association between job characteristics and the health and well-being of employed mothers and the differential susceptibility to job characteristics between coupled and single-parent mothers. METHODS: We used data from the 5th Portuguese National Health Survey from 1649 employed women (aged 25-54) living with a child under 16. We modelled depression (assessed by the Personal Health Questionnaire-8) and self-reported health as a function of job characteristics, adding interaction terms to compare coupled and single-parent mothers, using logistic regressions. RESULTS: Working part-time was associated with depression (odds ratio (OR) = 3.39, 95% confidence interval (CI) = 3.31-3.48) and less-than-good health (OR = 1.28, 95%CI = 1.26-1.31), compared to working full time. Compared to high-skill jobs, the likelihood for depression among low-skill occupations was lower among coupled mothers (OR = 0.25, 95%CI = 0.24-0.26), and higher among single-parent mothers (OR = 1.75, 95%CI = 1.54-1.99). Unstable jobs were associated with depression among coupled mothers. CONCLUSIONS: Part-time jobs are detrimental for mothers' mental health, but high-skilled jobs are protective for single-parent mothers. Part-time and unstable jobs are linked to poorer self-reported health among coupled mothers. Results question the gendered arrangements that may face employed coupled mothers.

Intergenerational transmission of parental smoking: when are offspring most vulnerable?

BACKGROUND: Previous literature has showed that the likelihood of smoking is higher among offspring with smoking parents. The aim of this cohort study is to investigate during which smoking initiation stages and at what ages adolescents are more likely to be influenced by parental smoking. METHODS: This study used the EPITeen Cohort, which recruited 13-year-old adolescents born in 1990, enrolled at schools in Porto, Portugal. Participants (n = 996) were followed across four waves at 13, 17, 21 and 24 years old. We computed the odds ratio (OR) and 95% confidence intervals for the prevalence of the different smoking states (never smoking, experimenter, less than daily smoker, daily smoker and former smoker), and incidence transitions between these states (to smoking experimenter; to less than daily smoker, to daily smoker; to former smoker) as function of age, parental smoking status and their interaction. RESULTS: Compared with other participants, those with two smoking parents had an increased prevalence of experimentation at 13 years (OR for the interaction at 13 years compared with 24 years = 2.13 [1.50-3.01]) and daily smoking at all ages (OR for parental smoking =1.91 [1.52-2.40]). The latter increase is related to a significantly increased risk to transit from early smoking stages to daily smoking at all ages (OR for parental smoking = 1.83 [1.43-2.34]). CONCLUSIONS: Parental smoking influences offspring's daily smoking prevalence especially by increasing the risk to transit to daily smoking up to early adulthood. Prevention should focus on parents and parental influences especially among offspring who may transition to daily smokers.

The association between socioeconomic position and vigorous physical activity among adolescents: a cross-sectional study in six European cities.

BACKGROUND: The relationship between socioeconomic position (SEP) and adolescent physical activity is uncertain, as most evidence is limited to specific settings and a restricted number of SEP indicators. This study aimed to assess the magnitude of socioeconomic differences in adolescent vigorous physical activity (VPA) across various European countries using a wide range of SEP indicators, including family-based (education, family affluence, perceived social standing, parents' employment, housing tenure) and adolescent-based (academic performance and pocket money) ones. METHODS: We used data from a survey among 10,510 students aged 14-17 from 50 schools in six European cities: Namur (BE), Tampere (FI), Hannover (DE), Latina (IT), Amersfoort (NL), Coimbra (PT). The questionnaire included socio-demographic characteristics and the amount of time spent in VPA. RESULTS: The mean time spent practicing VPA was 60.4 min per day, with lower values for Namur (BE) and Latina (IT), and higher values for Amersfoort (NL). In the multivariable analysis, both categories of SEP indicators (family-based and adolescent based indicators) were independently associated with VPA. For each SEP indicator, lower levels of VPA were recorded in lower socioeconomic groups. In the total sample, each additional category of low SEP was associated with a decrease in mean VPA of about 4 min per day. CONCLUSIONS: This study showed that across European cities adolescent VPA is positively related to both family-based SEP and adolescents' own SEP. When analysing socioeconomic differences in adolescent VPA, one should consider the use of multiple indicators of SEP.

Nicotine dependence among adolescents in the European Union: How many and who are affected?

BACKGROUND: Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups. METHODS: The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset. RESULTS: We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence. CONCLUSION: According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.

Destruction of the bronchial epithelium in patients with severe asthma according to different patterns of inflammation and cold airway hyperresponsiveness.

AIM: The aim of the research was to study the state of the bronchial mucosa epi-thelium in relation to the severity of clinical manifestations in severe uncon-trolled asthma depending on the pattern of inflammation and the presence of cold airway hyperresponsiveness. MATERIALS AND METHODS: In 48 patients with severe uncontrolled asthma, there were assessed asthma symptoms, clinical signs of cold airway hyperre-sponsiveness, and lung function; the samples of slides were analyzed in the cytological examination of the sputum; the degree of damage to epithelial cells and granulocytes was estimated using the total cell destruction index (CDI). RESULTS: According to the analysis of sputum cytograms, the patients were divided into two groups: group I (22 patients) included persons with eosin-ophilic inflammation pattern (31.0±3.1% of eosinophils and 22.0±2.2% of neutrophils), group II (26 patients) was with mixed inflammation pattern (7.2±1.4 and 71.8±4.2%, respectively). The patients of group II had lower disease control according to Asthma Control Test (ACT; 12.1±0.7 and 17.8±0.2 points, respectively; р<0.05), a greater frequency of exacerbations (4.1±0.3 and 3.2±0.2 per year, respectively; р<0.05), greater incidence of clinical signs of cold airway hyperresponsiveness (79 and 19%, respectively; χ2=14.18; р<0.001); lower lung function (midexpiratory flow rate MEF25-75 was 14.6±1.6 and 20.7±1.9%, respectively; р<0.05); they received a higher dose of the combined medications of inhaled glucocorticosteroid in controller anti-inflammatory therapy (salmeterol/fluticasone at a dose of 705.3±19.7 and 650.7±14.8 µg/day for fluticasone propionate; р<0.05) In patients of group II the correlations of epithelial CDI with neutrophil CDI (r=0.61; p<0.01) and eosinophil CDI (r=0.48; p<0.05), as well as correlation of ACT with neutrophil CDI (r=-0.71; p<0.01) and eosinophil CDI (r=-0.53; p<0.05) were found. CONCLUSION: The degree of destruction of the epithelium and granulocytes in the inflammatory patterns has diagnostic relevance for the assessment of the severity of the disease, clinical manifestations of the airway response to the cold trigger, and the inertia of achieving control in patients with severe un-controlled asthma.

Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly.

Background: Inequalities in the distribution of self-reported health (SRH) have been widely reported. Its higher expressivity among women, elderly and least educated groups has been partly attributed to differences in their health perceptions. However, this subjectivity may be masking the burden of mental illness in these groups. Thus, we sought to understand if depression symptoms mediate inequalities in SRH. Methods: SHARE waves 4 and 6, pertaining to Spain, Italy and Portugal, were used (n2011 = 8517, n2015 = 11 046). Inequalities in SRH were calculated, comparing the risk amongst education level, gender and age groups, adjusting for chronic diseases, functional limitations and country fixed effects. We then tested depression symptoms as mediators. Results: Depression symptoms were associated with poor SRH (odds ratio (OR)2011 = 1.379, OR2015 = 1.384, P < 0.001). Their inclusion reduced the magnitude of the association between SRH and education, annulled the statistical significance for age, and reversed the gender effect. As expected, chronic diseases and functional limitations remained significant predictors of poor SRH. Conclusions: Depression symptoms, together with chronic diseases and functional limitations, explain the poorer SRH of the least educated, female and older groups in the Southern European population. Therefore, tackling inequalities in SRH must require focusing on mental health issues, which disproportionately affect the most vulnerable groups.

Feeding dynamics, consumption rates and daily ration of wahoo Acanthocybium solandri in Indo-Pacific waters.

This study reports the diet composition of 363 wahoo Acanthocybium solandri captured from the Indo-Pacific. The study also provides the first estimates of consumption and daily ration for the species worldwide, which are important parameters for ecosystem models and may improve ecosystem-based fisheries management. Thirty-four prey taxa were identified from A. solandri stomachs with Scombridae having the highest relative importance. Actinopterygii comprised 96% of the total prey wet mass, of which 29% were epipelagic fishes, with 22% alone from Scombridae. There was no significant relationship between fish size and the size of prey items consumed. Feeding intensity, as measured by stomach fullness, did not significantly differ either among seasons or reproductive activity. The mean daily consumption rate was estimated as 344 g day-1 , which corresponded to a mean daily ration of 2·44% body mass day-1 . The results from this study suggest A. solandri is an opportunistic predator similar to other pelagic piscivores, worldwide.

Socio-economic inequalities in tobacco-related diseases in Portugal: an ecological approach.

OBJECTIVES: The existence of socio-economic (SE) inequalities in smoking is well demonstrated, but less is known about its consequences. This study measures SE inequalities in the prevalence of tobacco-related diseases (TRD) in Portugal, using a new area-based SE indicator. STUDY DESIGN: Ecological study. METHODS: In-patient data were used to identify TRD discharges at all Portuguese NHS hospitals for the year 2011. The definition of TRD incorporates malignant cancers, cardiovascular diseases, cerebrovascular diseases and respiratory diseases. We created an area-based SE indicator on the basis of census data, using factor analyses. The association between the prevalence of TRD and the SE indicators was measured using Generalized Linear Models. The spatial correlation of this indicator was assessed using variograms. RESULTS: Two area-based SE factors were identified at the parish level, reflecting (i) social position (education and occupation); and (ii) deprivation (overcrowding and manual occupations). Upper-social-class areas were associated with a lower prevalence of malignant cancers, cardiovascular, and respiratory diseases. CONCLUSION: We found significant inequalities in TRDs across Portuguese parishes using a newly created area-based SE indicator reflecting several SE dimensions. This result emphasizes that inequalities in smoking are reflected in inequalities in health, and should be tackled through equality-oriented area-based tobacco policies.

Influence of TRPV4 gene polymorphisms on the development of osmotic airway hyperresponsiveness in patients with bronchial asthma.

The effect of single nucleotide polymorphisms (SNP) of TRPV4 gene on the development of airway hyperresponsiveness (39.7% of cases) in response to the decrease in osmolarity under inspiration of distilled water aerosol was studies in 189 patients with uncontrolled bronchial asthma. rs6606743 SNP was found to significantly contribute to the development of osmotic airway hyperresponsiveness. Analysis of the dominant genetic model revealed substantial prevalence of AG + GG genotype frequency in the group of patients with asthma with osmotic hyperresponsiveness in comparison with the patients who had negative response to bronchoprovocation. In addition, carriers of GG or AG genotypes had significantly more profound decrease of lung function parameters in relation to A homozygous patients.

Naringenin attenuates mucous hypersecretion by modulating reactive oxygen species production and inhibiting NF-κB activity via EGFR-PI3K-Akt/ERK MAPKinase signaling in human airway epithelial cells.

Naringenin (Nar) is a flavonoid derived from plant foods. It has been shown to have anti-inflammatory properties. Many studies have shown that overexpression of reactive oxygen species (ROS) and nuclear factor-κB (NF-κB) leads to increased mucin (MUC) 5AC expression in chronic inflammation of the airway. In addition, some studies have reported that naringenin inhibits NF-κB activity in a murine model of asthma. We speculated that naringenin might be associated with mucous hypersecretion, but the molecular mechanisms remain to be defined. Our study has also investigated whether naringenin could inhibit production of ROS and the activity of NF-κB on the inflammatory pulmonary diseases induced by human neutrophil elastase (HNE) and reduce the mRNA and protein levels of MUC5AC as shown by reverse transcriptase-polymerase chain reaction and real-time PCR (RT-PCR). Serum total MUC5AC protein was detected by enzyme-linked immunosorbent assay (ELISA), the protein morphological changes of MUC5AC were also observed by immunofluorescence and confocal laser technology. Hyperactivation of epidermal growth factor receptor (EGFR) signaling is commonly involved in the mucous hypersecretion process and initiates both the activation of extracellular signal-related kinases 1/2 (ERK1/2) and of phosphatidylinositol 3-kinase (PI3K) and Akt kinase. NF-κB is a key factor downstream of PI3K/Akt signaling, which induces overexpression of the MUC5AC gene. Our data revealed that naringenin inhibited the activation of EGFR resulting in the downregulation of the enzyme activities. Naringenin also reduced the protein expressions of p-EGFR, PI3K, p-Akt, p-ERK1/2, and NF-κB as shown by western blotting. Furthermore, naringenin significantly inhibited PI3K/Akt and ERK MAPKinase signaling with a concurrent reduction in production of ROS and NF-κB activities. These results suggest that naringenin may play a protective role by minimizing mucous production during airway inflammation by down-regulating ROS production and inhibiting the NF-κB activity via EGFR-PI3K-Akt/ERK MAPKinase signaling pathway.

Multimorbidity and intention to retire: a cross-sectional study on 14 European countries.

OBJECTIVES: To describe the association between multimorbidity and intention of retirement in Europe and to understand whether this relationship is modified by the working environment and disability integration policies. METHODS: Participants were 11,790 employees aged 50-65 years old who responded to the sixth wave of SHARE project (2015). We modelled intention of retirement as a function of multimorbidity, adjusting for age, gender, education level, and household income by means of logistic models with country fixed effects. We then included the working conditions and an integration policy indicator as potential effect modifiers. RESULTS: Overall, 36.6% of participants reported multimorbidity and 56.1% were willing to retire earlier. Multimorbidity was significantly associated with intention of retirement (OR = 1.58, 95% CI 1.37-1.84). Unfavourable working conditions were positively related to the intention to retire (OR = 1.99, 95% CI 1.53-2.58), while the integration policy was unrelated (OR = 1.84, 95% CI 0.80-4.23). Both did not modify the studied association (interaction terms: OR = 1.14, 95% CI 0.77-1.67, and OR = 0.85, 95% CI 0.58-1.24, respectively). CONCLUSIONS: Multimorbidity is associated with intention of retirement in Europe. This association was unaltered by working conditions and integration policies.

The current and projected burden of multimorbidity: a cross-sectional study in a Southern Europe population.

In a context of increasing ageing of the population, it is crucial to better understand multimorbidity and its consequences. This study measured the prevalence of multimorbidity in a Southern Europe population and projected its evolution based on expected demographic changes. It also analysed its associated consequences on self-reported health status, functional capacity, and healthcare use. Our sample included all people aged 25-79 years (6679 men and 8517 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. Multimorbidity was measured by the presence of at least two self-reported chronic conditions. Multivariable regressions were used to assess the association of multimorbidity with health status, functional capacity, and healthcare use. The projected evolution of multimorbidity was based on official demographic projections. 43.9% of the Portuguese population self-reported the multimorbidity, which was more frequent among older people, women, and low-educated people. We found an association of multimorbidity with poorer health status (OR 3.32, 95%CI 2.60-4.24) and with limited functional capacity (OR 4.44, 95%CI 3.85-5.11). Multimorbidity was also associated with higher healthcare resource use, namely a 26% increased likelihood of hospitalization in the previous 12 months per additional comorbidity. We projected a 13.1% growth in the prevalence of multimorbidity until the year 2050. Multimorbidity affects a substantial share of the population and is expected to grow in the near future related to population ageing. The co-occurrence of chronic health conditions increases sharply with age and is associated with worse health status, reduced functional capacity, and increased healthcare use.

Cigarette smoke induces mucin hypersecretion and inflammatory response through the p66shc adaptor protein-mediated mechanism in human bronchial epithelial cells.

The p66Shc adaptor protein is a newly recognized mediator of mitochondrial dysfunction and might play a role in cigarette smoke (CS)-induced airway epithelial cell injury. CS can induce an excessive amount of reactive oxygen species (ROS) generation, which can cause mitochondrial depolarization and injury through the oxidative stress-mediated Serine36 phosphorylation of p66Shc. The excessive production of ROS can trigger an inflammatory response and mucin hypersecretion by enhancing the transcriptional activity of pro-inflammatory cytokines and mucin genes. Therefore, we speculate that p66Shc plays an essential role in airway epithelial cell injury and the process of mucin generation in CS-induced chronic inflammatory airway diseases. Our present study focuses on the role of p66Shc in ROS generation, and on the resulting mitochondrial dysfunction, inflammatory response and mucus hypersecretion in CS-stimulated human bronchial epithelial cells (16HBE). We found that CS disturbed the mitochondrial function by increasing the level of phosphorylated p66Shc in these cells and that the effects were significantly reduced by silencing p66Shc. Conversely, the ectopic overexpression of wild-type p66Shc enhanced these effects. We also found that high levels of ROS inhibited FOXO3a transcriptional activity, which led to NF-κB activation. Subsequently, activated NF-κB promoted pro-inflammatory cytokine production and mucin hypersecretion. Thus, manipulating p66Shc might offer a new therapeutic modality with which to treat chronic inflammatory airway diseases.

[Epidemiology of hip fractures and its social and economic impact. An update for 2014]. / ACTUALIZAÇÃO SOBRE O IMPACTO EPIDEMIOLÓGICO E SOCIOECONÓMICO DAS FRACTURAS DA EXTREMIDADE PROXIMAL DO FÉMUR.

Hip fractures (HF) following low-impact trauma are the most visible and dramatic consequences of osteoporosis (OP). It is estimated that within one year after HF, 20 to 30% of the patients die, 50-60% become disabled and only 30-40% fully recover their previous functional levels. Therefore, its medical, societal and economic impact is huge and it is not fully delivered by the event itself, but rather by its consequences. This paper aims to update data published by Branco et al. 2009 about epidemiology and burden of HF, specifically to revise the national data. In Portugal there have been 77,083 HF reported between 2000 and 2008 with increasing numbers with ageing along with due associated refracture and mortality rates. Recent results suggest a slight change at clinical level concerning the pharmacological approach for the treatment of HF, however it is still important to stay alert to the patients' needs and to their bone mineral density losses in order to avoid repeating the occurrence of these events, aiming to generate significant benefits in terms of health outcomes and due public expenditure.

Study on TRPV1-mediated mechanism for the hypersecretion of mucus in respiratory inflammation.

Transient receptor potential vanilloid 1 (TRPV1) is sensitized by the high affinity TrkA receptor, which promotes pro-inflammatory cytokine production and mediates mucus hypersecretion in bronchial epithelial cells. The purpose of this study was to investigate the mechanism of TRPV1-mediated mucus hypersecretion and respiratory inflammation. Firstly, using Western blot analysis we found that epidermal growth factor receptor (EGFR) and TRPV1 were highly co-expressed in human bronchial epithelial cells (HBE16) with HNE and capsaicin co-treated, the levels of pro-inflammatory cytokines and MUC5AC were also highly co-expressed; however, TRPV1 receptor expression was low in these cells with only HNE stimulation, which demonstrated that sensitization of TRPV1 was not increased in HBE16 cells treated with HNE alone. Secondly, the EGF receptor antagonist (AG1478) and the TrkA receptor inhibitor (K252a) significantly inhibited TRPV1 sensitivity and the expression of MUC5AC and pro-inflammatory cytokines. Furthermore, the PI3K inhibitor LY294002, the PKC inhibitor bisindoylmaleimide (BIM) and the TRPV1 antagonist capsazepine completely abrogated the EGF sensitizing effect. Furthermore, the hypoxia-inducible factor (HIF-1α) inhibitor 2-methoxyestradiol (2-ME2) decreased the activity of PKC by a specific pathway. These findings strongly suggest that TRPV1 sensitization influences the hypersecretion of mucus and inflammatory cytokines, is associated with the PI3K and PKC signaling pathways and is involved HIF-1α activity.