Beyond comorbidities, sex and age have no effect on COVID-19 health care demand.

This paper explores the associations between sex, age and hospital health care pressure in the context of the COVID-19 pandemic in Portuguese mainland municipalities. To represent the impact of sex and age, we calculated COVID-19 standardised incidence ratios (SIR) in Portuguese mainland municipalities over fourteen months daily, especially focusing on the Porto metropolitan area. A daily novel indicator was devised for hospital health care pressure, consisting of an approximation to the ratio of hospitalisations per available hospital medical doctor (HPI). In addition, 14-day incidence rates were also calculated daily (DIR14), both as an approach and an alternative to the current national pandemic surveillance indicator (which is not calculated with such regularity). Daily maps were first visualised to evaluate spatial patterns. Pearson's correlation coefficients were then calculated between each proposed surveillance indicator (SIR and DIR14) and the HPI. Our results suggest that hospital pressure is not strongly associated with SIR (r = 0.34, p value = 0.08). However, DIR14 bears a stronger correlation with hospital pressure (r = 0.84, p value < 0.001). By establishing the importance of tackling sex and age through the inclusion of these factors explicitly in an epidemiological monitoring indicator, and assessing its relationship with a hospital pressure indicator, our findings have public policy implications that could improve COVID-19 incidence surveillance in Portugal and elsewhere, contributing to advancing the management of potential pandemics in the near future, with a particular focus on local and regional territorial scales.

Altered serotonin innervation in the rat epileptic brain.

Studies in animal models of epilepsy revealed compromised serotonin (5-HT) transmission between the raphe nuclei and the brain limbic system. The goal of the present study was to evaluate the effects of epilepsy on the structural integrity of the dorsal (DR) and median (MnR) raphe nuclei and on the morphology of serotonergic fiber terminals in the dentate gyrus (DG), infralimbic cortex (IL) and medial septum (MS). The study was performed in adult Wistar rats using the kainate (9.5 mg/kg) status epilepticus (SE) model. Four months post-SE, the brainstem sections of the animals were immunostained for 5-HT, whereas the forebrain sections were immunostained for serotonin transporter (SERT). Stereological analysis revealed that epileptic rats, as compared to controls, had approximately 30% less 5-HT-stained cells in the interfascicular part of the DR, but twice as many 5-HT-stained cells in the MnR. Another finding was the reorganization of the 5-HT fiber network in all target areas analyzed, as indicated by the rightward shift of the density-size distribution histograms of SERT-stained fiber varicosities. Nonlinear regression analysis of these histograms revealed that SERT-stained varicosities were represented by two subpopulations characterized by distinct cross-sectional areas. The areal density of the small-sized varicosities was decreased in the DG (hilus and molecular layer), IL cortex (layers II/III) and MS, while that of the larger-sized varicosities was increased. The present results support the hypothesis that chronic epilepsy can trigger profound structural reorganization of the ascending serotonergic pathways in the rat brain.

Steinert syndrome and repercussions in dental medicine.

Steinert syndrome, also called myotonic dystrophy type 1, is a genetic disorder with autosomal dominant transmission characterized by myotonia and a multisystemic clinical picture that affects several tissues of the human body. The most common systemic phenotypes are: muscular, cardiac, respiratory, CNS, ocular, gynecological, digestive, orthopedical, as well as cognitive and psychological symptoms (cognitive decline). Muscles involved in voluntary movement are highly affected by myotonia especially distal muscles of upper limbs. These patients also show changes in face, chewing and pharynx muscles that can lead to swallowing and speech problems, dysphagia and in most cases to food aspiration and suffocation. Poor oral hygiene resulting from reduced motor mobility and reduced saliva flux can lead to gingival inflammation and periodontal disease. Other oral manifestations include disturbances at the temporomandibular articulation, dental occlusion changes and reduction in teeth number as a result of caries. Main causes of death are pneumonia and cardiac arrhythmias. The etiopathogeny of this syndrome is still not clear, conditioning the existence of a specific treatment for this disease. Nowadays, treatments consist on the release of the existing symptoms, in an attempt to give a better life quality to patients. It is very important to implement actions that can prevent complications and consequently decrease death. Treatments should be applied in an early stage of the disease. Bronchoscopy and artificial respiration should be used to prevent pneumonia, and regular electrocardiographic monitoring should be done to evaluate defects in the conductive system. Several approaches have been applied to rehabilitate swallowing dysfunction and avoid aspiration like videofluoroscopy, postural techniques and adjustment of diet type. It is the aim of this paper to clarify the ethiology, diagnosis, systemic and oral characteristics of the syndrome, as well as to discuss treatments to be applied according to patients affected organs.

A Gaussian random field model for similarity-based smoothing in Bayesian disease mapping.

Conditionally specified Gaussian Markov random field (GMRF) models with adjacency-based neighbourhood weight matrix, commonly known as neighbourhood-based GMRF models, have been the mainstream approach to spatial smoothing in Bayesian disease mapping. In the present paper, we propose a conditionally specified Gaussian random field (GRF) model with a similarity-based non-spatial weight matrix to facilitate non-spatial smoothing in Bayesian disease mapping. The model, named similarity-based GRF, is motivated for modelling disease mapping data in situations where the underlying small area relative risks and the associated determinant factors do not vary systematically in space, and the similarity is defined by "similarity" with respect to the associated disease determinant factors. The neighbourhood-based GMRF and the similarity-based GRF are compared and accessed via a simulation study and by two case studies, using new data on alcohol abuse in Portugal collected by the World Mental Health Survey Initiative and the well-known lip cancer data in Scotland. In the presence of disease data with no evidence of positive spatial correlation, the simulation study showed a consistent gain in efficiency from the similarity-based GRF, compared with the adjacency-based GMRF with the determinant risk factors as covariate. This new approach broadens the scope of the existing conditional autocorrelation models.

Implementing the World Mental Health Survey Initiative in Portugal - rationale, design and fieldwork procedures.

BACKGROUND: The World Mental Health Survey Initiative was designed to evaluate the prevalence, the correlates, the impact and the treatment patterns of mental disorders. This paper describes the rationale and the methodological details regarding the implementation of the survey in Portugal, a country that still lacks representative epidemiological data about psychiatric disorders. METHODS: The World Mental Health Survey is a cross-sectional study with a representative sample of the Portuguese population, aged 18 or older, based on official census information. The WMH-Composite International Diagnostic Interview, adapted to the Portuguese language by a group of bilingual experts, was used to evaluate the mental health status, disorder severity, impairment, use of services and treatment. Interviews were administered face-to-face at respondent's dwellings, which were selected from a nationally representative multi-stage clustered area probability sample of households. The survey was administered using computer-assisted personal interview methods by trained lay interviewers. Data quality was strictly controlled in order to ensure the reliability and validity of the collected information. RESULTS: A total of 3,849 people completed the main survey, with 2,060 completing the long interview, with a response rate of 57.3%. Data cleaning was conducted in collaboration with the WMHSI Data Analysis Coordination Centre at the Department of Health Care Policy, Harvard Medical School. Collected information will provide lifetime and 12-month mental disorders diagnoses, according to the International Classification of Diseases and to the Diagnostic and Statistical Manual of Mental Disorders. CONCLUSIONS: The findings of this study could have a major influence in mental health care policy planning efforts over the next years, specially in a country that still has a significant level of unmet needs regarding mental health services organization, delivery of care and epidemiological research.

Cura no terceiro nível: estudo de um caso clínico

Após uma breve discussão teórica sobre os conceitos de saúde, doença e cura, e como eles se articulam na homeopatia, procuramos definir e entender cura noterceiro nível. A análise do caso clínico permitiu que pudéssemos acompanhar os elementos da discussão teórica, aprofundando a compreensão do processo de cura desde a resolução de um quadro agudo, a melhora progressiva na direção da cura, até a elaboração das questões mais profundas da paciente. Finalizamos com uma reflexão sobre a prática atual da medicina e futuros caminhos de estudos e pesquisa sobre o tema na homeopatia.