Bovine Tuberculosis - Analysis of 10-year cases and impact of visual inspection in the surveillance at the slaughterhouse in Portugal.

Bovine Tuberculosis (bTB) is a One Health issue that interconnects human health with animal and environmental health. Due to its importance, cattle (the main host) it is under a national eradication programme in Portugal. Within it, meat inspection is considered a cost-effective procedure in bTB surveillance. The Commission's Implementing Regulation (EU) 2019/627 changed the post-mortem meat inspection requirements applied to cattle, essentially reducing handling and incisions in young cattle (<8 months). To study the impact of these changes on the surveillance of bovine Tuberculosis, data (age, sex, fitness, breed, lesions, laboratory results and post-mortem decisions) on suspected and confirmed cases of bTB detected at routine slaughter of the period from October 2010 to January 2020 were analysed. From a total of 3,279,548 slaughtered animals, meat inspection detected 808 suspected cases. Of these, 381 cases were laboratory confirmed. The estimated global prevalence was 11.6 cases/100,000, increasing with age: 3.5, 5.9 and 27.3 cases/100,000 in, respectively, the groups <8 months, 8 to 19 months, and ≥ 20 months. The prevalence was higher in females (16.3 vs 7.3 cases/100,000 in males) and in beef cattle (16.3 vs 1.4 cases/100,000 in dairy cattle). Among the confirmed cases, mediastinal and bronchial lymph nodes were the most reported locations. Based on the results, there is no evidence of a negative impact on the application of Regulation (EU) 2019/627 on bTB surveillance in animals ≥8 months. For the <8 months group the change to a visual inspection protocol could lead to a failure in the detection of bTB cases. Considering the epidemiological situation, the incision of the mediastinal, bronchial and retropharyngeal lymph nodes in cattle <8 months should be maintained.

Phenotypic antimicrobial resistance (AMR) of avian pathogenic Escherichia coli (APEC) from broiler breeder flocks between 2009 and 2018.

Colibacillosis is one of the most important diseases in poultry production. The use of antimicrobials remains a therapeutic cornerstone for avian pathogenic E. coli (APEC), thereby contributing to the development of antimicrobial resistance (AMR). The aim of this study was to characterize AMR in broiler breeder flocks reared under commercial conditions. Data covering 10 years, from 2009 to 2018, were used to evaluate the phenotypic AMR of 264 APEC isolates obtained from 158 broiler breeder flocks of a large company in Portugal. The APEC isolates were tested against eleven antimicrobials by the Kirby-Bauer disc diffusion test. The annual proportion of AMR was calculated by dividing the number of APEC isolates with phenotypic resistance by the total number of APEC isolated that year. Similarly, the overall AMR of the whole period was calculated. The relationship of antimicrobial resistance with time (years) was investigated with a generalized linear model using logistic regression. The overall AMR of the 10-year period was: amoxicillin 78%, ampicillin 73.5%, tetracycline 63.3%, doxycycline 56.4%, apramycin 34.5%, neomycin 68.2%, enrofloxacin 32.6%, flumequine 39.4%, co-trimoxazole 47.7%, florfenicol 46.6% and lincospectin 66.3%. Over time, a significant decrease in AMR was observed for amoxicillin and ampicillin, neomycin, flumequine, co-trimoxazole, florfenicol and lincospectin. Multidrug resistance (MDR) decreased from 100% in 2009 to 48% in 2018. Only seven (2.7%) APEC strains were fully susceptible to all tested antimicrobials. The decrease over time of AMR in APEC likely reflects the efficacy of manifold improvements in broiler breeder production systems. A further reduction in AMR is still desirable. RESEARCH HIGHLIGHTSDecreasing trend of antimicrobial resistance in avian pathogenic E. coli over time.Over 50% of isolates still resistant to amoxicillin, tetracycline and doxycycline.Multidrug resistance decreased from 100% in 2009 to 48% in 2018.Further reduction of antimicrobial resistance in broiler breeders desirable.

Management of HIV-2 resistance to antiretroviral therapy in a HIV-1/HIV-2/HBV co-infected patient.

BACKGROUND: The current standard of care is to start antiretroviral therapy in all patients diagnosed with HIV-1, as for HIV-2 current DHHS guideline suggests ART for HIV-2 as soon as diagnosis is established, although this practice is not universal, for instance, in Portugal there are specific criteria to start treatment. CASE PRESENTATION: We present a case of a man, chronically infected with HIV-1, HIV-2 and hepatitis B virus who developed resistance to HIV-2 while maintaining HIV-1 under control. 6 years after starting antiretroviral therapy he had his first virologic failure. We performed HIV-2 resistance tests that revealed high-grade resistance to all nucleoside reverse-transcriptase inhibitors except tenofovir and to all protease inhibitors except darunavir. After a decade of permanent poor adherence to therapy he developed resistance to both tenofovir and darunavir. We put together a new regiment with tenofovir alafenamide + emtricitabine + dolutegravir + maraviroc and nowadays he is with undetectable HIV-1 and HIV-2 viral loads. CONCLUSIONS: This shows the importance of having access to HIV-2 viral load determination and HIV-2 resistance testing.

Artemether-lumefantrine treatment failure of uncomplicated Plasmodium falciparum malaria in travellers coming from Angola and Mozambique.

The failure of artemisinin combination therapy (ACT) in malaria patients returning from endemic regions may be driven by parasite resistance to this treatment. ACT is used globally as the first-line treatment for Plasmodium falciparum malaria. However, artemisinin-resistant strains of P. falciparum have emerged and spread across Southeast Asia, with the risk of reaching high malaria burden regions in Africa and elsewhere. Here, we report on two malaria imported cases from Africa with possible parasite resistance to the ACT artemether-lumefantrine (AL). Case presentation: Two middle-aged males returning from Angola and Mozambique developed malaria symptoms in Portugal, where they were diagnosed and received treatment with AL as hospital inpatients. After apparent cure and discharge from hospital, these individuals returned to hospital showing signs of late clinical failure. Molecular analysis was performed across a number of drug resistance associated genes. No evidence of pfk13-mediated artemisinin resistance was found. Both subjects had complete parasite clearance after treatment with non-ACT antimalarials. Conclusion: Our case-studies highlights the need for close monitoring of signs of unsatisfactory antimalarial efficacy among AL treated patients and the possible implication of other genes or mutations in the parasite response to ACTs.

Associations between depressive symptoms and being employed or retired in older adults with type 2 diabetes.

AIMS: Analyse the association of depression with retirement in older adults with type 2 diabetes(T2D). METHODS: Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) was used to analyse 1100 T2D aged 51-74, employed or retired. Multilevel logistic models examined the relationships of health and socio-demographic characteristics with depression. RESULTS: The proportion of females was significantly higher among those with depression. Around half of those aged between 51 and 64 were employed, and less than 5% among those aged between 65 and 74 years. Female, employment, more chronic diseases and not perceiving their health as healthy were associated with depression among those aged 51-64. Among women, the odds of being depressed was significantly higher among those employed than among those who had retired. Among men, being employed or retired was not significantly associated with depression. CONCLUSIONS: Depression was associated to more limitations of daily living and chronic diseases, and worst perception of health. The majority of those with depression were women, and being retired seems to have a protective effect on women.

An update of the profile of older adults with dementia in Europe: findings from SHARE.

Background: The increase in longevity due to the reduction of premature deaths has led to an increase of the number of people with dementia. The objective of the present work was to analyze the profile of the European population with dementia aged more than 50.Methods: The sample of individuals aged 51 or more years was taken from a European database within the last wave of the SHARE Project (Wave 6, March 2017). Participants with and without a diagnosis of dementia were compared in terms of socio-demographic, general health, mental health, behavioural risks, education and employment, by age group. Categorical variables were compared using chi-square test, quantitative variables were compared with the independent sample t-test.Results: From 45,340 subjects (40% males) 897 (2%) had dementia. The findings corroborate recent evidence stating that individuals with dementia have a lower physical and mental health as well as a lower quality of life than people without dementia. It was also verified that people with dementia: (i) had a lower employment rate; (ii) showed lower levels of formal education; (iii) less were living a married life; (iv) exhibited a moderate pattern of behavioural risks, but had higher levels of physical inactivity; (v) had more chronic diseases and (iv) higher intake of more than 5 drugs per day. The unfavourable health and well-being status of dementia subjects was found in all age groups.Conclusions: An update of the profile of older Europeans with dementia was performed with data from 18 countries. The findings of co-morbidity, high rates of intake of more than 5 drugs daily and low levels of well-being irrespective of age should be considered in the assessment and management of dementia in the European population.

Misperception of Healthy Weight: Associations Among Weight, Body Size Satisfaction and Body Appreciation in Older Adults.

Misperceived body weight in older people can affect their health and quality of life. We analysed the body image of older adults in Primary Health Care services in central Portugal, by considering participants' weight, body size satisfaction and body appreciation. This epidemiological and cross-sectional study involved 150 participants (56% women) with an average age of 74.9 years who completed questionnaires on body size and body appreciation. Forty-nine percent of participants were affected by overweight and 29% by obesity. The majority was not satisfied with their body size (71.2%), but had very high scores related to body appreciation. Around 40% of the participants with normal weight or overweight were satisfied with their body size. Multiple regression analysis revealed that both body size satisfaction and appreciation were negatively associated with obesity, but not with overweight. Older Portuguese adults are not able to assess if their weight is a risk to their health, but regardless of their perceived physical appearance, the elderly respect their body and are receptive to improving their health.

Obesity in Older Type 2 Diabetic Patients: Does Working Environment Add Vulnerability?

Little is known about how working adults with type 2 diabetes are managing their health. This study aims to analyze the associations between health, behavioral, and sociodemographic characteristics and obesity in older diabetic patients in Europe. Data from the Survey of Health, Ageing, and Retirement in Europe was used to compare 1447 participants that were identified as having type 2 diabetes with 28,047 participants without diabetes. Multilevel logistic models stratified by type 2 diabetes examined the relationships of health, behavioral, and sociodemographic characteristics with obesity. The proportion of physical inactivity was significantly higher among those with type 2 diabetes (15.0% vs. 6.1%). Individuals with diabetes had more chronic diseases, more limitations in activities, higher body mass index, more depression, lower quality of life and well-being, and lower employment rate. Among those with type 2 diabetes, those employed were more likely to be obese (OR = 1.377, 95% CI, 1.023 to 1.853) and women were 52% more likely to be obese than men. The surveillance of weight in working environments should be required within workers with type 2 diabetes. It is concluded that this and other adjustments could be beneficial in people with diabetes.

Food Chain Information: Data Quality and Usefulness in Meat Inspection in Portugal.

Food chain information (FCI) is a mandatory component of meat inspection in the European Union. In Portugal there has been no assessment of FCI regarding risk-based meat inspection. The goal of the present study was to assess the quality and the usefulness of data provided by farmers. A total of 1,694 reports (989 for bovine animals, 575 for swine, and 130 for small ruminants) submitted to nine red meat slaughterhouses between September 2015 and January 2017 were analyzed. These reports covered a total of 79,889 animals. Overall, information was provided for the majority of the general identification items. To assess the quality of the information on health status, medication, disease occurrence, diagnostic tests, and results of previous ante- and postmortem exams, responses were classified as plausible, "nothing to declare," invalid, and nonresponse. Plausible information was provided by farmers on health status, medication, tests, and diseases on 82.7, 24.6, 5.4, and 0.1% of the FCI forms, respectively. More than 70% of the responses in all categories except health status were "nothing to declare." In pigs, when comparing ante- and postmortem inspection results with the corresponding FCI, no relevant contribution of the FCI was observed. Inaccurate or irrelevant information was provided for the majority of the detailed questions, impeding the formulation of appropriate risk-based meat inspection decisions. Farmers seem to have difficulty providing specific information. Better forms and better training are needed. Information on the prevalence of biological hazards relevant to public health currently is not available. Our results support the need to improve the systems used to obtain and integrate relevant information from the farm to the slaughterhouse.

Threats to Health and Well-Being Perceived by Older People in Poland and Portugal.

INTRODUCTION: According to the OECD, Portugal and Poland rank below average in several well-being measures such as income and wealth, and health status. Investigating how people perceive the threats to health in these two countries, is an important issue to address priority needs. To meet this need, the objective of this paper was to compare the perceptions of the threats to the health and well-being among the Polish and Portuguese older persons and explore differences between the countries in respect of patterns of self-rated health. MATERIAL AND METHODS: A Cross-sectional study with two convenience samples from primary health care services of Poland and Portugal was conducted; 480 adults aged 65 and over (247 Portuguese) were included. The EASYCare standard assessment of 2010 was applied under a joint project of both countries. The association between 'self-rated unhealthy' and socio-demographic and threats to health variables was examined using logistic regression. RESULTS: In both countries about two thirds of the older persons self-rated their health as unhealthy. Having more than enough finances was associated with a significant lower odds of being unhealthy compared with those without enough finances at the end of the month (Portugal: OR = 0.25, 95% CI 0.10 to 0.63; Poland: OR = 0.33, 95% CI 0.12 to 0.88). Visual problems, bodily pain, memory loss, feeling bored or lonely and reporting shortness of breath during normal activities was consistently associated with fair or poor self-rated health. DISCUSSION: These findings provide important information regarding the health profile of older people which can help in the development of people-centred health systems where their lives and well-being can be improved. CONCLUSION: The unhealthy perception of older people was consistently associated with indicators of major health threats.

Introdução: De acordo com a Organização para a Cooperação e Desenvolvimento Económico, Portugal e Polónia ficam abaixo da média em várias medidas de bem-estar, como renda e riqueza, e estado de saúde. Investigar como as pessoas percecionam as ameaças à saúde nesses dois países, é uma questão importante para atender a necessidades prioritárias sentidas. Para atender a essa necessidade, o objetivo deste trabalho é comparar as perceções das ameaças à saúde e ao bem-estar entre as pessoas idosas polacas e portuguesas e explorar as diferenças entre os países, no que respeita aos padrões da auto-perceção do estado de saúde. Material e Métodos: Foi realizado um estudo transversal com duas amostras de conveniência nos Cuidados de Saúde Primários na Polónia e em Portugal; foram incluídos 480 adultos com 65 anos ou mais (247 portugueses). A avaliação padrão EASYCare de 2010 foi aplicada no âmbito de um projeto conjunto em ambos os países. A associação entre 'perceção não saudável' e as variáveis sociodemográficas e ameaças à saúde foi examinada através da regressão logística. Resultados: Em ambos os países cerca de dois terços das pessoas idosas avaliaram a sua saúde como não saudável. O fato de ter finanças mais do que suficientes produziu uma menor probabilidade de não ser saudável em comparação com aqueles cujas finanças não eram suficientes no final do mês (Portugal: OR = 0,25, IC 95%: 0,10 a 0,63; Polónia: OR = 0,33; IC 95%: 0,12 a 0,88). Problemas visuais, dor corporal, perda de memória, sentir-se aborrecido ou solitário e trefrir dificuladade respiratória durante as atividades normais foi consistentemente associado com uma saúde autoavaliada razoável ou insatisfatória. Discussão: Estes resultados fornecem informações importantes sobre o perfil de saúde de pessoas idosas, o que poderá ajudar no desenvolvimento de sistemas de saúde centrados nas pessoas em que as suas vidas e bem-estar possam ser melhorados. Conclusão: A perceção não saudável das pessoas mais velhas apresentou-se consistentemente associada a indicadores de principais ameaças para a saúde.

A Comparison Among Three Multiplex Y-STR Profiling Kits for Sexual Assault Cases.

Biological evidence of sexual assault is one of the most difficult sample types to analyze in forensic laboratories. Y-STR markers are thus a valuable tool for analyzing these samples. The aim of this project was to compare three Y-STR commercial kits by analyzing their amplification performance on casework samples. Overall, 247 trace samples were analyzed with a Yfiler® Plus PCR Amplification Kit (Applied Biosystems), PowerPlex® Y23 (Promega® ) System and AmpFLSTR® Yfiler™ PCR Amplification Kit (Applied Biosystems). Comparing the amplification performance of the three kits, the first two were significantly more sensitive than the latter (p < 0.001). For samples, with a male DNA quantity less than 0.5 ng, the PowerPlex Y23® kit was the most sensitive and best performing kit, followed by the Yfiler® Plus kit (p = 0.009). In conclusion, the Yfiler® Plus and PowerPlex Y-23® kits are viable alternatives to older kits for samples with low amounts of male DNA.

When the Diagnosis is a Victim of the Circumstances.

INTRODUCTION: Haemoptysis is a common symptom which can sometimes mimic gastrointestinal bleeding. CASE DESCRIPTION: We describe the case of a 31-year-old man who presented to the emergency department after an episode of sudden nausea and presumed massive haematemesis. The situation was interpreted as gastrointestinal bleeding but clinical evolution and greater attention to the anamnesis resulted in a diagnosis of pulmonary tuberculosis and the provision of appropriate care. DISCUSSION: This report emphasizes the difficulty of differentiating between haemoptysis and haematemesis and the importance of a careful anamnesis and attention to all clinical circumstances for an accurate diagnosis. LEARNING POINTS: Haematemesis and haemoptysis are not always distinguished from each other when a patient's history is being collected.Despite being a rare manifestation of tuberculosis, in the correct epidemiological context, haemoptysis should raise the suspicion of pulmonary tuberculosis.The clinical setting and the need for immediate care should not limit clinical investigation or the differential diagnosis.

Reliability and validity of the EASYCare-2010 Standard to assess elderly people in Portuguese Primary Health Care / Fiabilidad y validez del EASYCare-2010 Standard para evaluar a las personas mayores en Atención Primaria de Salud en Portugal

INTRODUCTION: The EASYCare is a multidimensional assessment tool for older people, which corresponds to the concerns and priorities of older people in relation to their needs, health, and quality of life. The EASYCare instrument has been used in many countries worldwide. Lack of reliability evidence has recently been raised by researchers. This study aimed to test the validity and reliability of the EASYCare-2010 instrument in community-dwelling Portuguese older people attended in Primary Health Care centres. METHODS: The sample for this transversal study (N = 244) was collected from Portuguese Primary Health Care Centers. Categorical Principal Component Analysis was used to assess the underlying dimensions of EASYCare-2010. Construct validity was evaluated through correlation with the World Health Organization Quality of Life Assessment Instrument-Short Form. RESULTS: A two-factor model (labelled "mobility and activities of daily life", and "general well-being and safety") was found. The EASYCare-2010 instrument showed acceptable levels for internal consistency (≥0.70). The EASYCare-2010 factors were correlated with measures of quality of life. Results showed that in most polytomous items, some of the more extreme categories were not considered at all or only by a residual number of participants. CONCLUSION: EASY Care -2010 version is a valid and reliable instrument for holistic assessment of the older people attended in Primary Health Care centres in Portugal

INTRODUCCIÓN: El EASYCare es una herramienta de evaluación multidimensional para las personas mayores, que corresponde a las preocupaciones y prioridades de las personas mayores en relación con sus necesidades, salud y calidad de vida. El instrumento EASYCare se ha utilizado en muchos países del mundo. La falta de pruebas de fiabilidad ha sido planteada recientemente por los investigadores. Este estudio tuvo como objetivo probar la validez y fiabilidad del instrumento EASYCare-2010 en personas mayores portuguesas residentes en la comunidad, atendidos en centros de Atención Primaria de la Salud. MÉTODOS: La muestra para este estudio transversal (N = 244) se recogió en Centros de Atención Primaria de Portugal. Se utilizó el Análisis de Componentes Principales Categórico para evaluar las dimensiones subyacentes de EASYCare-2010. La validez del constructo se evaluó mediante la correlación con el instrumento de evaluación de la calidad de vida de la Organización Mundial de la Salud, instrumento en su forma corta. RESULTADOS: Se encontró un modelo de dos factores (denominado «movilidad y actividades de la vida diaria» y «bienestar general y seguridad»). El instrumento EASYCare-2010 mostró niveles aceptables de consistencia interna (≥ 0.70). Los factores EASYCare-2010 se correlacionaron con medidas de calidad de vida. Los resultados mostraron que en la mayoría de ítems politómicos en algunas categorías extremas no se consideraron o solo por un número residual de participantes. CONCLUSIÓN: La versión EASY Care-2010 es un instrumento válido y fiable para la evaluación holística de las personas mayores atendidas en centros de Atención Primaria de Salud en Portugal

Meat Safety: An Evaluation of Portuguese Butcher Shops.

Butcher shops are end points in the meat chain, and they can have a determinant role in cross-contamination control. This study aims to determine whether Portuguese butcher shops comply with European and Portuguese law regarding the sale of fresh meat and meat products. Butcher shops (n = 73) were assessed for meat handler and facility hygiene and for maintenance of the premises. Handlers (n = 88) were given a questionnaire composed of questions about knowledge and practice, including hazard analysis and critical control point (HACCP) and good practice in food industry, to assess their knowledge of and compliance with food safety practices. A checklist of 27 items was used to evaluate facility and meat handler hygiene and butcher shop maintenance. Our results revealed some lack of compliance in all the areas evaluated. The mean knowledge and practice score among the operators was 68.0%, and the mean "visual inspection" score for the butcher shops was 64.0%. Severe deficiencies were observed in the mandatory implementation of HACCP principles in this type of small food business. These findings indicate a need to modify training to enhance compliance with European food safety regulations at this step of the meat chain.

Reliability and validity of the EASYCare-2010 Standard to assess elderly people in Portuguese Primary Health Care.

INTRODUCTION: The EASYCare is a multidimensional assessment tool for older people, which corresponds to the concerns and priorities of older people in relation to their needs, health, and quality of life. The EASYCare instrument has been used in many countries worldwide. Lack of reliability evidence has recently been raised by researchers. This study aimed to test the validity and reliability of the EASYCare-2010 instrument in community-dwelling Portuguese older people attended in Primary Health Care centres. METHODS: The sample for this transversal study (N=244) was collected from Portuguese Primary Health Care Centers. Categorical Principal Component Analysis was used to assess the underlying dimensions of EASYCare-2010. Construct validity was evaluated through correlation with the World Health Organization Quality of Life Assessment Instrument-Short Form. RESULTS: A two-factor model (labelled "mobility and activities of daily life", and "general well-being and safety") was found. The EASYCare-2010 instrument showed acceptable levels for internal consistency (≥0.70). The EASYCare-2010 factors were correlated with measures of quality of life. Results showed that in most polytomous items, some of the more extreme categories were not considered at all or only by a residual number of participants. CONCLUSION: EASY Care -2010 version is a valid and reliable instrument for holistic assessment of the older people attended in Primary Health Care centres in Portugal.

Validation of the Orbach & Mikulincer Mental Pain Scale (OMMP) on a drug addicted population.

PURPOSE: Recognizing the relevance of mental pain in drug addiction, this study aimed to adapt and validate the Portuguese translation of the Orbach & Mikulincer Mental Pain Scale (OMMP) on a drug addicted population and assess its psychometric properties. METHODS: The study sample (N = 403) was collected from several outpatient treatment centres for drug addiction and in therapeutic communities located in the north of Portugal. The validation of the OMMP Scale followed the same method considered by the authors of the original scale. RESULTS: A confirmatory factor analysis (CFA) was performed and did not confirm the structure of eight factors provided by the authors. An exploratory factor analysis revealed a five-factor model (labeled emptiness, irreversibility, emotional flooding, helplessness and confusion) leading to a reduction from 40 to 24 items. The OMMP-24-P showed acceptable levels for internal consistency and test-retest reliability. Confirmatory factor analysis indices supported the five-factor model. OMMP-24-P factors were positively correlated with measures of stress, anxiety and depression, negatively associated with quality of life, and showed small to moderate positive correlations with drug addiction severity, with exception of the helplessness factor. CONCLUSIONS: This study has shown the OMMP-24-P to be a valid and reliable scale for assessment and evaluation of mental pain among drug addicts. Further research should attempt to determine the contribution that mental pain can provide towards an understanding of drug addiction dynamics and other psychopathological syndromes, and thereby contribute to the development of more effective treatment programs.

Salmonella cross-contamination in swine abattoirs in Portugal: Carcasses, meat and meat handlers.

In this study the occurrence of Salmonella in swine, pork meat and meat handlers along with their clonal relatedness is evaluated at abattoir level. Samples from the lymph nodes, carcass surface and meat of 100 pigs and 45 meat handlers were collected in eight abattoirs (July 2007-August 2008). Salmonella isolates were serotyped and genotyped by pulsed-field gel electrophoresis (PFGE). From the pigs tested, 42 produced at least one positive sample. A relatively high frequency of Salmonella occurrence was found in the ileoceacal lymph node samples (26.0%), followed by carcass (16.0%) and meat samples (14.0%). However, ileoceacal lymph nodes that test positive for Salmonella are not found to be a predictor of positive test results further on in the process. Besides the slaughterhouse environment, meat handlers were identified as a possible source of subsequent contamination, with 9.3% of the sample testing positive. Diverse Salmonella enterica serotypes were detected, mainly S. Typhimurium and the monophasic variant S. 4,[5],12:i:-, but also S. Derby, S. Rissen, S. Mbandaka, S. London, S. Give, S. Enteritidis and S. Sandiego, in total corresponding to 17 PFGE types. Our results demonstrate that besides a high level of Salmonella swine contamination at pre-harvest level, slaughtering, dressing, cutting and deboning operations are contributing to the occurrence of clinically relevant clones (e.g. S. Typhimurium DT104 and S. 4,[5],12:i:-) in pork products. This study also highlights the possibility of an ongoing Salmonella community being spread by abattoir workers.

Lung cancer and indoor radon exposure in the north of Portugal--an ecological study.

BACKGROUND: Indoor radon exposure is a well documented environmental factor as a leading cause of lung cancer. OBJECTIVES: The aim of this study was to assess the risk of lung cancer and estimate the number of deaths due to indoor radon exposure in the north of Portugal, between 1995 and 2004. METHODS: The sixth Biological Effects of Ionizing Radiation Committee (BEIR VI) preferred models were applied to estimate the risk of developing lung cancer induced by indoor radon exposure, by age and level of exposure, and calculated the number of lung cancer deaths attributable to this exposure. Lung cancer mortality data were granted by the North Regional Health Administration and indoor radon concentrations resulted from a national survey conducted by the Portuguese Environmental Agency. The smoking habit was accounted with two methods. A submultiplicative interaction between smoking and indoor radon exposure was considered. RESULTS: Depending on the model applied and the method used to account for the smoking habit, the estimated number of lung cancer deaths attributed to indoor radon exposure, in northern Portugal, ranges from 1565 to 2406, for the period between 1995 and 2004. This indicates that of the 8514 lung cancer deaths observed, from 18 to 28% could be associated with indoor radon exposure. CONCLUSIONS: This was the first study realized in Portugal on the impact of indoor radon exposure in lung cancer mortality. The application of the BEIR VI models led to a high number of lung cancer deaths due to indoor radon exposure.

Serum homocysteine concentrations in Portuguese young adults reference interval.

INTRODUCTION AND OBJECTIVES: Hyperhomocysteinemia has been shown to be an independent risk factor for cardiovascular disease. Assessing the reference intervals for homocysteine among young adults is a critical step in the process of preventing cardiovascular diseases later in life. This study aimed to identify reference intervals for total serum homocysteine concentration in young adults. METHODS: The sample was composed of 469 (74.4% female) young adults (mean age 20.4 ± 2.1) who participated in an ongoing longitudinal study of apparently healthy undergraduate students registered in different academic years and different scientific areas in a Portuguese University, and coming from all regions of the country. Total homocysteine concentrations were determined and the data were analyzed employing the Hoffmann approach. This approach method has been widely used to evaluate reference intervals for various analytical parameters. Reference intervals (5th and 95th percentiles) for the total homocysteine concentration were first estimated by gender and since male and female reference intervals were similar, one reference interval for total homocysteine was estimated irrespective of gender. RESULTS: Reference intervals showed to be similar for both genders. The reference range, for homocysteine in young Portuguese adults, was 6.2-11.6 µmol/l, regardless of gender. Above 11.6 µmol/l surveillance should be considered in young adults. CONCLUSIONS: This is the first known study providing reference intervals for total homocysteine in young adults, based on a sample of Portuguese university students. The identification of a reference interval for total serum homocysteine concentration at these ages may help to identify those with a higher cardiovascular disease risk. Values above 11.6 µmol/L should lead physician concern and surveillance in adulthood.