Age Unplugged: A Brief Narrative Review on the Intersection of Digital Tools, Sedentary and Physical Activity Behaviors in Community-Dwelling Older Adults.

This brief narrative review assesses how digital technologies-such as wearables, mobile health apps, and various digital tools such as computers, game consoles, tablets, smartphones, and extended reality systems-can influence sedentary and physical activity behaviors among community-dwelling older adults. Each section highlights the central role of these technologies in promoting active aging through increased motivation, engagement and customized experiences. It underlines the critical importance of functionality, usability and adaptability of devices and confirms the effectiveness of digital interventions in increasing physical activity and reducing sedentary behavior. The sustainable impact of these technologies needs to be further investigated, with a focus on adapting digital health strategies to the specific needs of older people. The research advocates an interdisciplinary approach and points out that such collaborations are essential for the development of accessible, effective and ethical solutions. This perspective emphasizes the potential of digital tools to improve the health and well-being of the aging population and recommends their strategic integration into health promotion and policy making.

Crossing the digital frontier: are older adults ready for virtual reality workouts?

In the dynamic web of our digital age, virtual reality (VR) is crystallizing as a promising medium for promoting physical activity in older adults, overcoming age-old barriers. This perspective article explores the intricate synergy between VR and physical activity in older adults and highlights the many challenges of aging within a virtual environment. While VR heralds the potential for multisensory interaction and cognitive enhancement, a thorough assessment of its impact is paramount. The reach of VR goes beyond immediate applications and permeates the emotional and psychological realms of the human journey. Such an exploration requires a comprehensive perspective that goes beyond a purely technical assessment. The aim of this article is not to present clear-cut solutions, but to encourage reflection on the diverse impact of VR on our aging population. We argue for a future in which technology complements, rather than eclipses, the depth of human experience.

Determinantes do comportamento sedentário de idosos que residem em Portugal: análise temática qualitativa a partir da SOS-framework / Determinantes del comportamiento sedentario entre las personas mayores que viven en Portugal: un análisis temático cualitativo basado en el marco SOS / Determinants of sedentary behavior in elderly people living in Portugal: qualitative thematic analysis from the SOS-framework

O processo de envelhecimento resulta num declínio geral das capacidades do indivíduo. Associado ao comportamento sedentário (CS), que traz inúmeras consequências para a saúde, torna-se importante perceber e criar estratégias que modifiquem este comportamento, no sentido depromover uma melhor qualidade de vida. Assim, o objetivo deste estudo foi identificar e compreender quais os determinantes do CS de idosos que residem em Portugal. Participaram no estudo 12 idosos, com idades entre os 71 e os 86 anos (M = 78,92 anos; DP =6,52), que responderam a uma entrevista semiestruturada. Os dados recolhidos foram analisados tendo como base uma perspetiva interpretativa, assumindo uma ontologia relativista e uma epistemologia subjetivista. Os resultados revelaram determinantes que foram reunidos em seis grupos: Saúde e Bem-Estar, Contexto Social e Cultural, Comportamento e Psicologia, Ambiente Construído e Natural, Configurações institucionais/domiciliares e, Política e Economia. Os determinantes mais mencionados pelos participantes para se manterem em CS foram as limitações físicas, as atividades organizadas em grupo (sentados), a solidão, a falta de motivação e de instalações para saírem de casa, as políticas institucionais, o conforto do quarto e, por último, as autoridades locais que não realizam atividades, por vezes, por falta de recursos financeiros. Desta forma, percebemos que o CS é determinado por diversos fatores e todos eles estão relacionados entre si, contudo, não podemos generalizar, sendo necessária uma análise individual e contextual específica, para se ajustarem as estratégias ao indivíduo/grupo. (AU)

El proceso de envejecimiento provoca una disminución general de las capacidades del individuo. Asociado al comportamiento sedentario, que tiene numerosas consecuencias para la salud, es importante entender y crear estrategias para modificar este comportamiento, con el fin de promover una mejor calidad de vida. Por lo tanto, el objetivo de este estudio fue identificar y comprender los determinantes del comportamiento sedentario entre las personas mayores que viven en Portugal. Participaron en el estudio 12 personas mayores de entre 71 y 86 años (M = 78,92 años; DT = 6,52), que completaron una entrevista semiestructurada. Los datos recogidos se analizaron desde una perspectiva interpretativa, asumiendo una ontología relativista y una epistemología subjetivista. Los resultados revelaron determinantes que se agruparon en seis grupos: Salud y bienestar, Contexto social y cultural, Comportamiento y psicología, Entorno construido y natural, Entorno institucional/doméstico y, Política y economía. Los determinantes más mencionados por los participantes para permanecer en el CS fueron las limitaciones físicas, las actividades organizadas en grupo (sentarse), la soledad, la falta de motivación y de facilidades para salir de casa, las políticas institucionales, la comodidad de la habitación y, por último, las autoridades locales que no realizan actividades, a veces por falta de recursos económicos. Así, nos damos cuenta de que el comportamiento sedentario está determinado por varios factores y todos ellos están relacionados entre sí; sin embargo, no podemos generalizar, y se requiere un análisis contextual individual y específico para ajustar las estrategias al individuo/grupo. (AU)

The aging process results in a general decline in the individual's abilities. Associated with sedentary behavior, which has numerous health consequences, it is important to understand and create strategies to modify this behavior in order to promote a better quality of life. Thus, the aim of this study was to identify and understand the determinants of sedentary behavior among the elderly living in Portugal. Twelve elderly aged between 71 and 86 years (M = 78.92 years; SD = 6.52) participated in the study and answered a semi-structured interview. The data collected were analyzed based on an interpretive perspective, assuming a relativistic ontology and a subjectivist epistemology. The results revealed determinants that were gathered into six groups: Health and Well-Being, Social and Cultural Context, Behavior and Psychology, Built and NaturalEnvironment, Institutional/Household Settings, and, Politics and Economy. The determinants most mentioned by participants for staying in sedentary behavior were physical limitations, organized group activities (sitting), loneliness, lack of motivation andfacilities to leave home, institutional policies, room comfort, and lastly, local authorities that do not carry out activities sometimes due to lack of financial resources. Thus, we realize that sedentary behavior is determined by several factors andtheyare all related to each other; however, we cannot generalize, and an individual and specific contextual analysis is necessary to adjust strategies to the individual/group. (AU)

The Quiet Epidemic: An Overview of Emerging Qualitative Research Trends on Sedentary Behavior in Aging Populations.

Sedentary behavior poses a significant health risk to older adults. The purpose of this scoping review is to summarize key findings from qualitative research (since 2012), with a focus on explaining prevailing research trends and patterns within the field. This review included 25 studies that met the strict inclusion criteria. Five key research themes have emerged: (1) defining and shaping perspectives of sedentary behavior, (2) understanding the dynamics of daily routines and contexts, (3) raising awareness of older adults' perceived advantages and disadvantages of sedentary behavior, (4) identifying its determinants and discouraging factors, and (5) exploring interventions to promote active behaviors and reduce sedentary behavior. These themes highlight the multifaceted nature of SB and underscore the importance of tailoring interventions to address individual, social, and environmental issues. A comprehensive understanding of SB is critical to developing effective strategies to promote active lifestyles and reduce SB in older adults. Further qualitative research is needed to deepen our understanding and develop targeted interventions and strategies.

Knowledge in Motion: A Comprehensive Review of Evidence-Based Human Kinetics.

This comprehensive review examines critical aspects of evidence-based human kinetics, focusing on bridging the gap between scientific evidence and practical implementation. To bridge this gap, the development of tailored education and training programs is essential, providing practitioners with the expertise and skills to effectively apply evidence-based programs and interventions. The effectiveness of these programs in improving physical fitness across all age groups has been widely demonstrated. In addition, integrating artificial intelligence and the principles of slow science into evidence-based practice promises to identify gaps in knowledge and stimulate further research in human kinetics. The purpose of this review is to provide researchers and practitioners with comprehensive information on the application of scientific principles in human kinetics. By highlighting the importance of evidence-based practice, this review is intended to promote the adoption of effective interventions to optimize physical health and enhance performance.

Characterization of Innovation to Fight Child Mortality: A Systematic Scoping Review.

Objectives: This study aims to summarize how child mortality-a Sustainable Development Goal stated by the United Nations-has been explicitly addressed in the context of innovations. Methods: A scoping review following the PRISMA-ScR Statement was performed analysing indexed and non-indexed literature. Results: Empirical and non-disruptive innovation in the context of process targeting under-five mortality rate was the main subset of literature included in this article. The increment of literature on innovation in the context of SDGs over the last years denotes its growing importance and even though innovation aiming to reduce child mortality is currently being done, a significant part of it is not published in indexed databases but as grey literature. Conclusion: Empirical, disruptive innovation under a structural approach and empirical, non-disruptive innovation under a project point of view are the main types of innovation addressed in the literature and would be of utmost potential to reduce child mortality rate. A systematic review of the methods used for the measures of evaluation of applied innovations, their quality and results would be of great importance in the future.

COVID-19 patients followed in Portuguese Primary Care: a retrospective cohort study based on the national case series.

BACKGROUND: The pandemic state caused by SARS CoV-2 came to overburden all levels of healthcare, including Primary Care. In Portugal, most patients were followed in ambulatory, monitored by phone calls or face-to-face visits by their General Practitioner. OBJECTIVE: The aim was to characterize the pathway of COVID-19 outpatients in Primary Care and establish the risk factors that mostly influences the need for hospitalization or death during the follow-up. METHODS: A retrospective cohort study was established, based on the official Portuguese dataset of the first wave between March 2nd and June 30th 2020. The predictive effects of variables, including age, gender, residency and clinical features, were analysed using Cox regression analysis. RESULTS: A total of 38,545 patients infected with SARS-CoV-2 was included for analysis (56.3% female), with a median age of 47 years old. There were 4,327 hospitalized patients, 253 in intensive care units and 1,153 deaths. Females present lower risk of hospitalization (HR = 0.78; 95% CI: 0.73-0.82; P < 0.001) and age is associated with higher risk (HR = 7.08; 95% CI: 6.68-7.50; P < 0.001), as well as the presence of at least one comorbidity (HR = 7.03; 95% CI: 6.43-7.69; P < 0.001). Multivariate analysis showed that cardiovascular disease, diabetes, smoking, obesity, chronic kidney disease, cancer, chronic obstructive pulmonary disease, HIV and other immunodeficiencies, transplant or immunosuppression, haematological disorders, neurological disorders and liver disease increased the risk of hospitalization. CONCLUSION: Male gender, age and the presence of comorbidities are the main determinants for hospitalization and death. These COVID-19 patients should receive a higher attention when they come to primary care for assistance.

Portuguese Primary Healthcare and Prevention Quality Indicators for Diabetes Mellitus - A Data Envelopment Analysis.

BACKGROUND: Diabetes mellitus (DM) is a worldwide public health priority. The increasing prevalence and the budget constraints force to have effective healthcare, especially at the primary healthcare (PHC) level. We aim to assess primary care efficiency considering the best use of human resources to produce optimal diabetes care in terms of prevention quality indicators (PQIs) rates across national ACES (health centre groupings). METHODS: We conducted a two-stage data envelopment analysis (DEA) to assess the technical efficiency of 54 Portuguese primary care health centre groupings for the 2016-2017 biennium. In the first stage, efficiency scores were obtained through five output-oriented DEA models under vector return to scale (VRS) assumption, using three input variables representing key primary care human resources and one output representing each one of the five PQIs related to diabetes. In the second stage, Tobit regression models were estimated to assess the determinants of primary care efficiency in diabetes care. RESULTS: A total of 13 ACES reached the efficiency frontier. Better managing human resources could reduce PQI rates by 52.3% in 2016 and 49.1% in 2017. Higher proportion of patients under 65 years old and better controlled with a hemoglobin A1c (HbA1c) ≤6.5% were associated with better efficiency in diabetes care, whereas higher prevalence of DM and unemployment worsened hospitalizations rates by diabetes short-term complications and lower-extremity amputation. CONCLUSION: Inefficiency in DM care was found in most of the primary care settings which can substantially improve the avoidable hospitalization rates by DM using their current level human resources. These findings help to improve diabetes care by targeting human resources at primary care level, which should be integrated into performance assessments considering broader and integrated scopes.

Suicide Mortality Rate as a Sustainable Development Goal (SDG): A Bibliometric Analysis.

Suicidal behaviors are a serious but potentially preventable cause of premature death. Increased awareness of the importance of mental health for global health has led to new initiatives, supported by the World Health Organization (WHO) and the United Nations (UN). The suicide mortality rate is one of the indicators covered in the UN's Sustainable Development Goal (SDG) 3. The aim of this study is to identify the scientific production and its temporal evolution related to the suicide mortality rate indicator in the context of mental disorders and as one of the SDG. A bibliometric analysis was performed in Scopus to assess the related research on suicide mortality rate, including on the context of the third SDG, from inception to September 2, 2020. The set of articles were analyzed for bibliometric measures. A total of 3126 documents about mental health and suicide mortality rate on the context of SDG were collected. Articles were the predominant type of literature on this area (78.3%), with significant expression on the last years, more evident around 2015, the year of adoption of SDGs. Despite a large volume of evidence, the debate about suicide mortality rate as an indicator of SDG is still very sparse suggesting a need for better consensus on its evaluation methods. This study presents useful characteristics for the formulation of new studies and provides specific targets for the construction or improvement of public policies on the context of the SDGs for further discussion on this strategy proposed by the UN.

Emerging Qualitative Research Trends (2010-2021) on Sedentary Behaviour among Older Adults: A Systematic Literature Review Protocol.

In recent years, research on sedentary behaviour has increased. In this regard, there is a need for theoretical reviews that allow us to determine the past, analyse the present, and prepare the future of research in this field. The purpose of this review paper was to analyse and organise the emerging qualitative research trends (2010-2021) on the sedentary behaviour of older adults. A systematic literature search strategy was developed in various electronic scientific databases (e.g., PubMed, Web of Science, ScienceDirect, Scielo, and Scopus). The included studies were required to have different qualitative methodological approaches in terms of data collection and methods of data analysis. Studies conducted in any country and published in a peer-reviewed journal in English, Spanish, and Portuguese were considered. A thematic analysis approach was used for data extraction and synthesis, and confidence in the results was assessed using the GRADE-CERQual approach. This study may enable accurate guidelines to be established for future primary qualitative research related to sedentary behaviour.

Analysis of root causes of problems affecting the quality of hospital administrative data: A systematic review and Ishikawa diagram.

INTRODUCTION: Administrative hospital databases represent an important tool for hospital financing in many national health systems and are also an important data source for clinical, epidemiological and health services research. Therefore, the data quality of such databases is of utmost importance. This paper aims to present a systematic review of root causes of data quality problems affecting administrative hospital data, creating a catalogue of potential issues for data quality analysts to explore. METHODS: The MEDLINE and Scopus databases were searched using inclusion criteria based on two following concept blocks: (1) administrative hospital databases and (2) data quality. Studies' titles and abstracts were screened by two reviewers independently. Three researchers independently selected the screened studies based on their full texts and then extracted the potential root causes inferred from them. These were subsequently classified according to the Ishikawa model based on 6 categories: "Personnel", "Material", "Method", "Machine", "Mission" and "Management". RESULTS: The result of our investigation and the contribution of this paper is a classification of the potential (105) root causes found through a systematic review of the 77 relevant studies we have identified and analyzed. The result was represented by an Ishikawa diagram. Most of the root causes (25.7%) were associated with the category "Personnel" - people's knowledge, preferences, education and culture, mostly related to clinical coders and health care providers activities. The quality of hospital documentation, within category "Material", and aspects related to financial incentives or disincentives, within category "Mission", were also frequently cited in the literature as relevant root causes for data quality issues. CONCLUSIONS: The resultant catalogue of root causes, systematized using the Ishikawa framework, provides a compilation of potential root causes of data quality issues to be considered prior to reusing these data and that can point to actions aimed at improving data quality.

Career Development of Adapted Sports Coaches: Systematic Review of Qualitative Evidence Literature.

This study aims to synthesize and understand the qualitative and empirical evidence previously published on adapted sports career development. This systematic literature review also aimed at developing a conceptual model of the training and career path of adapted sports coaches. The research was carried out through the following databases: PubMed, Erid, EBSCO, Web of Science and Scopus. We selected nine qualitative studies according to the specific eligibility criteria. Data extraction was carried out independently by different authors, including the assessment of the methodological quality of the articles. We developed a conceptual model composed of four descriptive subjects (adapted sport option; perception of training athletes in adapted sports; development of the adapted sports coach's learning; adapted sports coach reality) about the adapted sports coach's pathway and added three analytical subjects about the difficulties, opportunity and reality of adapted sports. The conceptual model suggests inclusion of practical activity programs, the specificities of related contents with the adapted modalities, and observation in a real context are fundamental.

Physical fitness in children in Cabo Verde: differences between gender, eutrophic vs overweight subjects, and practitioners vs nonpractitioners of sports.

PURPOSE: There are few or even rare studies conducted in Cabo Verde that address the issue of physical fitness and body composition in the juvenile population. This investigation aims to study the Physical Fitness in children in Cabo Verde: differences between gender, eutrophic and overweight subjects, between practitioners and non-practitioners of sports. METHODS: The sample consisted of 93 individuals aged between 10 and 15 years, from the 2nd and 3rd cycles and secondary school of the Portuguese College based in Cabo Verde. The instruments used for data collection were the FITescola® test battery, and the questionnaire (QAPACE) (Quantification de l'activite physique en altitude chez les enfants) for assessment of physical activity level. Regarding the statistical analysis using the SPSS 23.0 Software, the first analysis was performed to verify the distribution of the sample (Kolmogorov-Smirnov and Shapiro-wilk). Then, for variables with normal distribution we used the t-test and for the remaining variables with nonnormal distribution we used the Mann-Whitney test, with a significance level of 5%. RESULTS: Gender differences were found, in which the male gender obtained more favorable mean values in the "sit-ups", "push-ups", "horizontal impulsion", "shuttle" and "agility" variables, while the females showed superiority in the variables "sit and reach"; differences between the eutrophic and overweight group where, as expected, more favorable mean values for eutrophics than the overweight group in all PF tests. Finally, differences between practitioners and nonpractitioners of sports, with the best results being attributed to practitioners of sports. CONCLUSIONS: We concluded that male subjects have greater proficiency in strength and aerobic fitness tests while female subjects have greater flexibility. High BMI values in overweight children have been found to be associated with increased abdominal fat as well as a reduction in overall PF. As expected, sports practitioners show better results in motor performance on PF tests.

The effect of commissioning on Portuguese Primary Health Care units' performance: A four-year national analysis.

BACKGROUND: Portugal underwent a paradigmatic Primary Health Care (PHC) reform in 2005. The reform implemented better health information systems, goal-oriented management, pay-for-performance schemes, functional autonomy for the front-line units, and the general adoption of commissioning processes. Since the implementation of the reform, the same set of indicators have been monitored nationally every year. However, from 2014-2016, the five Regional Health Administrations could individually select part of set of indicators to be commissioned. As the same some indicators were used commissioned in some regions, but not in others, a natural experimental setting to observe the impact of commissioning on the results by comparing the performance of commissioned versus non-commissioned indicators emerged and the effects of commissioning on PHC performance could be evaluated. AIM: Our article aims to clarify the effect of commissioning on the results achieved by PHC units in Portugal following the implementation of the reform. RESULTS: In general, the indicator values improved with time in the three types of units that existed after the reform. However, Model B Family Health Units ('Unidades de Saúde Familiar' or USFs that use pay-for-performance and are more mature) obtained the highest absolute indicator values, followed by Model A USFs (newer units with a fixed salary) and Personalised Health Care Units ('Unidades de Cuidados de Saúde Personalizados' that were created under the model before the reform and offer a fixed salary), respectively. CONCLUSION: The results show a general increase in indicators in all PHC units. However, the indicators used in the commissioning processes exhibited a greater increase. There was no evidence that the better results exhibited by the commissioned indicators were achieved at the expense of a detrimental effect on non-commissioned indicators.

Improving medication adherence in hypertensive patients: A scoping review.

In recent years, interest in medication adherence has greatly increased. Adherence has been particularly well studied in the context of arterial hypertension treatment. Numerous interventions have addressed this issue, however, the effort to improve adherence has been often frustrating and frequently disorganized. The aim of present study was to perform a scoping review of medication adherence interventions in hypertensive patients, so that a clear overview was achieved. Moreover, an evidence-based categorization of interventions was developed. The review was performed according to the PRISMA-ScR statement. MEDLINE and Web of Science were searched, and studies published from database inception until August 17, 2020 were included. A total of 2994 non-duplicate studies were retrieved. After screening and eligibility phases, a total of 45 articles were included. Studies were analyzed regarding their design, participant characteristics and management of adherence strategies employed. Furthermore, medication adherence and blood pressure outcomes, as well as adherence measuring tools were evaluated. Each study's intervention was then categorized using a novel evidence-based system of categorization, derived from the conceptual clustering framework used in machine learning. This work is an important step in pushing for better informed and more efficient future research efforts, both by providing an overview of the research field and by creating a new, evidence-based intervention categorization tool. It also provides valuable information to clinicians about medication adherence to antihypertensive therapy.

Coffea canephora breeding: estimated and achieved gains from selection in the Western Amazon, Brazil / Melhoramento do Coffea canephora: ganhos de seleção estimados e realizados na Amazônia Ocidental

ABSTRACT: Gain from selection is an important criterion in quantifying the efficiency of breeding programs. This study quantified the selection gain estimated under experimental conditions and realized gain achieved in the field, seeking to interpret the efficiency of the Coffea canephora selection. For that purpose, we considered experiments that began in 2004 with directed hybridizations to obtain new hybrid progenies. From a breeding population composed of 288 hybrid individuals, 12 genotypes were selected in experimental conditions from 2005 to 2012, with amplitude in the estimated gains from 127.70 to−19.19%. Those genotypes were evaluated from 2012 to 2018 in clonal tests in four environments of the Western Amazon. The environment that exhibited the greatest correlation between the predicted genetic values and the realized genetic gain observed in the field was the environment of Ouro Preto do Oeste, RO (0.67), the location in which the plants were selected, followed by the environments of Alta FlorestaD´Oeste, RO (0.44), Rio Branco, AC (0.43), and Porto Velho, RO (0.37).Experimental conditions showed that the effect due to dominance deviations was approximately three times greater than the additive effect. Nine clones exhibited higher genetic gains in the experimental conditions and at field, and two clones exhibited lower estimated gains and lower field performance.The clone G17-P7 exhibited high genetic gain under experimental conditions and low field performance. The selection in experimental conditions was positively correlated with plant performance in the field (r=0.55), which allows reduction of the original breeding population to a set of more promising clones to be grown in multiple environments, optimizing time and resources.

RESUMO: O ganho com a seleção é um dos critérios mais importantes para avaliar a eficiência de programas de melhoramento de plantas. O objetivo desse trabalho é quantificar a associação entre o ganho de seleção estimado em condições experimentais e o ganho de seleção realizado em campo, buscando quantificar a eficiência do melhoramento do Coffea canephora. Para isso, foram considerados experimentos iniciados com a hibridação direcionada para obtenção de progênies no ano de 2004, a avaliação de testes de progênies em condições experimentais no período de 2005 a 2012, e avaliações em diferentes ambientes da Amazônia Ocidental no período de 2012 a 2018. De uma população composta por 288 indivíduos estruturados em nove progênies de irmãos completos foram selecionados 12 genótipos com amplitude de 127,70 a -19,19% em suas estimativas de ganho com a seleção, para serem avaliados em quatro ambientes da Amazônia Ocidental. O ambiente que apresentou maior correlação entre os valores genéticos preditos e o ganho realizado foi Ouro Preto do Oeste - RO (0,67), local em que as plantas foram selecionadas, seguido pelos ambientes de Alta Floresta D´Oeste - RO (0,44), Rio Branco - AC (0,43) e Porto Velho - RO (0,37). Avaliações em condições experimentais mostraram que os efeitos devido aos desvios de dominância foram aproximadamente três vezes maiores do que os efeitos aditivos. Nove clones apresentaram maiores estimativas de ganho em condições experimentais e nos ensaios de campo, e dois clones apresentaram menores estimativas em ambas condições. O clone G17-P7 apresentou altas estimativas de ganho em condições experimentais e baixo desempenho em campo. A seleção em único ambiente esteve positivamente correlacionada com o desempenho dos cafeeiros em campo (r=0,55), permitindo reduzir a população de melhoramento original em um conjunto de clones de maior potencial agronômico.

Landscapes on Prevention Quality Indicators: A Spatial Analysis of Diabetes Preventable Hospitalizations in Portugal (2016-2017).

Preventable hospitalizations due to complications of diabetes mellitus (DM), represented by the related prevention quality indicators (PQI), are ambulatory care-sensitive conditions that can be prevented and controlled through effective primary health care (PHC) treatment. It is important to reduce mortality and promote the quality of life to diabetic patients in regions with higher hospitalization rates. The study aims to analyze the results of the DM age-sex-adjusted PQI, by groups of health centers (ACES), distributed in the Portuguese territory. The most representative PQI at a national level were identified, and the trends were mapped and analyzed. Also, it presents the ACES with the highest age-adjusted rates of avoidable hospitalizations for DM. The absolute number of preventable hospitalizations for all DM complications in Portugal has decreased by 20%, thus passing from the rate of 79 in 2016 to 65.2/100,000 inhabitants in 2017. Despite the improvement in results for PQI 03, 20 of 48 ACES that were above the national 2017 median rate in 2016, achieved better results the following year, and for the overall preventable diabetes hospitalizations (PQI 93) only 11 out 39, revealing the need for further studies and PHC actions to improve the diabetic quality of life.

Geospatial Analysis of Environmental Atmospheric Risk Factors in Neurodegenerative Diseases: A Systematic Review.

Despite the vast evidence on the environmental influence in neurodegenerative diseases, those considering a geospatial approach are scarce. We conducted a systematic review to identify studies concerning environmental atmospheric risk factors for neurodegenerative diseases that have used geospatial analysis/tools. PubMed, Web of Science, and Scopus were searched for all scientific studies that included a neurodegenerative disease, an environmental atmospheric factor, and a geographical analysis. Of the 34 included papers, approximately 60% were related to multiple sclerosis (MS), hence being the most studied neurodegenerative disease in the context of this study. Sun exposure (n = 13) followed by the most common exhaustion gases (n = 10 for nitrogen dioxide (NO2) and n = 5 for carbon monoxide (CO)) were the most studied atmospheric factors. Only one study used a geospatial interpolation model, although 13 studies used remote sensing data to compute atmospheric factors. In 20% of papers, we found an inverse correlation between sun exposure and multiple sclerosis. No consensus was reached in the analysis of nitrogen dioxide and Parkinson's disease, but it was related to dementia and amyotrophic lateral sclerosis. This systematic review (number CRD42020196188 in PROSPERO's database) provides an insight into the available evidence regarding the geospatial influence of environmental factors on neurodegenerative diseases.

The state of health in the European Union (EU-28) in 2017: an analysis of the burden of diseases and injuries.

BACKGROUND: The Global Burden of Disease study has generated a wealth of data on death and disability in Europe. At a time of change for the European Union and European Region of WHO, with a new Health Commissioner and Regional Director, respectively, a review of health trends can contribute to identify outstanding needs and gaps. This paper reports a summary of the burden of disease in the European Union (EU) in 2017 (compared with 2007). METHODS: For the whole EU and each country, mortality by causes of death, disability-adjusted life years (DALYs) and life expectancies are reported. RESULTS: In 2017, the age-standardized mortality and DALY rates were of 452.6 and 19 663.3 per 100 000 inhabitants, respectively. The diseases contributing most to mortality were ischaemic heart disease (IHD), dementias and stroke, while low back pain and IHD accounted for the highest burden of DALYs. CONCLUSIONS: Overall, there was an improvement in the state of health in the EU but substantial differences between countries remain. Cardiovascular diseases still represent the major burden, although there have been substantial improvements. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

The Sedentary Time and Physical Activity Levels on Physical Fitness in the Elderly: A Comparative Cross Sectional Study.

BACKGROUND: Ageing is a life-long process characterized by a progressive loss of physical fitness compromising strength, flexibility, and agility. The purpose of this study was to use accelerometry to examine the relationship between sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) with the elderly's physical fitness. Additionally, we aimed to examine the association between the aforementioned variables on older adults who fulfilled global recommendations on physical activity for health and on those who did not fulfil these recommendations. METHODS: Eighty-three elderly (mean ± SD: 72.14 ± 5.61 years old) of both genders volunteered to participate in this cross-sectional study, being divided into an active group (n = 53; 71.02 ± 5.27 years old) and an inactive group (n = 30; 74.13 ± 5.72 years old) according to the established guidelines. Sedentary and physical activity times were assessed using an ActiGraph® GT1M accelerometer, whereas physical fitness was evaluated with the Senior Fitness Test. RESULTS: MVPA time was correlated with lower body mass index (BMI) ((rs = -0.218; p = 0.048; -0.3 < r ≤ -0.1 (small)) and shorter time to complete the agility test ((rs = -0.367; p = 0.001; -0.5 < r ≤ -0.3 (low)). Moreover, MVPA time was positively correlated with aerobic endurance ((rs = 0.397; p = 0.000; 0.5 < r ≤ 0.3 (low)) and strength ((rs = 0.243; p = 0.027; 0.3 < r ≤ 0.1 (small)). In the inactive group, MVPA time was positively correlated with upper limb flexibility ((rs = 0.400; p = 0.028; 0.5 < r ≤ 0.3 (low)); moreover, sedentary time was negatively correlated with upper limb flexibility ((r = -0.443; p = 0.014; -0.5 < r ≤ -0.3 (low)), and LPA time was negatively correlated with BMI ((r = -0.423; p = 0.020; -0.5 < r ≤ -0.3 (low)). In the active group, MVPA time was correlated with lower BMI ((rs = -0.320; p = 0.020; -0.5 < r ≤ -0.3 (low)), and shorter time to complete agility test ((rs = -0.296; p = 0.031; -0.3 < r ≤ -0.1 (small)). CONCLUSIONS: Our results reinforce the importance of promoting MVPA practice among the elderly, thereby allowing physical fitness maintenance or improvement.