Adolescents and young adults' concerns under stress, the COVID-19 pandemic: a Portuguese cross-sectional study.

Background: Adolescents and young adults are a critical target regarding reducing healthrisk behaviors' adoption, particularly in a stressful context such as the COVID-19 pandemic. Surveying their perceptions and behavioral changes may lead to a revised health promotion approach. Objectives: This study aims to describe adolescents' and young adults' early reactions to a stressful event, the COVID-19 pandemic, characterizing their social determinants and preferences, such as sources of information, experienced symptoms, habits, and main concerns regarding themselves, their relatives, and the community. We intended to explore the association of their concerns and significant determinants such as age, gender, education, source of information, feelings of fear, prospecting the implications of communication, and individual and social determinants in managing stressful events. Methods: We conducted a cross-sectional, population-based, self-report survey of 3,898 individuals aged between 16 and 24 years from Portugal. Results: The main concerns about COVID-19 were the possibility of transmitting to someone and permanent social changes. Our findings present significant differences according to gender, education, age, and expressing fear. Conclusion: The pandemic deteriorated baseline community inequalities. Young people appreciate official information and are available to contribute to society's safety. However, valuing official information is associated with deeper expressed concerns. Therefore, official information should include strategies to reach young people, promote healthier choices, and avoid distress and disinformation.

Trace Elements in Portuguese Children: Urinary Levels and Exposure Predictors.

Exposure to environmental chemicals during developmental stages can result in several adverse outcomes. In this study, the exposure of Portuguese children to Cu, Co, I, Mo, Mn, Ni, As, Sb, Cd, Pb, Sn and Tl was evaluated through the analysis of first morning urine through ICP-MS. Furthermore, we attempted to determine possible exposure predictors. The study sample consisted of 54% girls and 46% boys, with a median age of 10 years; 61% were overweight/obese and were put on a nutritionally oriented diet. For I, half of the population was probably in deficiency status. The median urinary concentrations (µg/L) were Cu 21.9, Mo 54.6, Co 0.76, Mn 2.1, Ni 4.74, As 37.9, Sb 0.09, Cd 0.29, Pb 0.94, Sn 0.45, Tl 0.39 and I 125.5. The region was a significant predictor for Cu, Co, Ni, As and Tl. Children living in an urban area had higher urinary levels, except for Co and Ni. Age was a significant predictor for Cu, I, Mo, Mn, Ni, Sb, Cd and Sn with urinary levels of these elements decreasing with age. No sex-related differences were observed. Diet and weight group were predictors for urinary Cu, Mn, Ni, Sb and As. Significant differences were observed between the diet/weight groups for Cu, Ni, Sb and As, with the healthy diet group presenting higher values.

Gambling Disorder among Porto's University Students.

BACKGROUND: Gambling disorder is an emerging problem among young adults and must be researched to provide the necessary support. This study aims to characterise gambling disorders in Porto's university students. METHODS: A cross-sectional study distributed an online questionnaire to Porto's university students. The authors developed a self-administered questionnaire that included the South Oaks Gambling Screen questionnaire-Portuguese Version (SOGS-PV). RESULTS: A total of 1123 responses were included. The participants' average age was 22.4 years (SD = 6.2), and 60.9% were women. Gambling activities were performed by 66.4% of the students, most commonly online or video games, "scratch card" games, skill games, lotteries, and sports bets. The final scores of the SOGS-PV suggested 19.7% (95% CI: 17.4-22.0) of students may have a gambling disorder, with 16.6% (95% CI: 14.4-18.8) being "probable pathological gamblers" and 3.1% (95% CI: 2.1-4.1) being "problem gamblers". Gambling in the stocks/commodities market/virtual coins, sports bets, playing cards for money, and the numbers or betting on lotteries presents a higher risk of gambling disorder. The age (OR: 0.953; 95% CI: 0.922-0.986), being male (OR: 2.756; 95% CI: 1.899-4.000), the highest daily gambling amount (OR: 3.938; 95% CI: 2.580-6.012), the effects of the COVID-19 pandemic (OR: 0.129; 95% CI: 0.087-0.191), a mother with gambling disorder (OR: 5.284; 95% CI: 1.038-26.902), the personal services education area (OR: 2.858; 95% CI: 1.179-6.929), and the linguistics education area (OR: 2.984; 95% CI: 1.538-5.788) stand out as contributing factors to the development of this disorder. CONCLUSIONS: This study reveals a high level of possible gambling disorder among university students and emphasises the importance of this problem in the academic community. Physician awareness and prevention programmes are needed in this population.

Young People Awareness of Sexually Transmitted Diseases and Contraception: A Portuguese Population-Based Cross-Sectional Study.

Adolescents and young adults are an important target concerning reducing health-risk behavior adoption, including sexual health. Studying their knowledge concerning sexuality and their main counsellors, can be an important step in targeting an updated health promotion approach. This study characterized adolescents and young adults' knowledge and attitudes about sexually transmitted diseases (STDs), and contraception, prospecting for their main trusted counseling sources. We conducted a cross-sectional, population-based, self-report survey of 746 individuals aged between 14 and 24 years from Paredes, Portugal. The questionnaire included many dimensions, as demographic characteristics, youth behavior, currently sexually active status, main counselors concerning health topics, awareness, and knowledge about STDs and contraception. Mean age of the participants was 18.3 years, 50.5% of them had started their sexual activity. Males present themselves as more sexually active, starting earlier, and have more sexual partners than females. Participants reported an adequate knowledge perception about STDs and contraception methods, however we found different patterns on specific STDs and contraceptive methods, according to gender, age, and sexually active status. Our results help design specific interventions to reach youth, community, and healthcare providers, pointing out the value of bringing people to the center of health policies.

Phylogeography of Sub-Saharan Mitochondrial Lineages Outside Africa Highlights the Roles of the Holocene Climate Changes and the Atlantic Slave Trade.

Despite the importance of ancient DNA for understanding human prehistoric dispersals, poor survival means that data remain sparse for many areas in the tropics, including in Africa. In such instances, analysis of contemporary genomes remains invaluable. One promising approach is founder analysis, which identifies and dates migration events in non-recombining systems. However, it has yet to be fully exploited as its application remains controversial. Here, we test the approach by evaluating the age of sub-Saharan mitogenome lineages sampled outside Africa. The analysis confirms that such lineages in the Americas date to recent centuries-the time of the Atlantic slave trade-thereby validating the approach. By contrast, in North Africa, Southwestern Asia and Europe, roughly half of the dispersal signal dates to the early Holocene, during the "greening" of the Sahara. We elaborate these results by showing that the main source regions for the two main dispersal episodes are distinct. For the recent dispersal, the major source was West Africa, but with two exceptions: South America, where the fraction from Southern Africa was greater, and Southwest Asia, where Eastern Africa was the primary source. These observations show the potential of founder analysis as both a supplement and complement to ancient DNA studies.

Phthalates and type 1 diabetes: is there any link?

Phthalates are a group of chemical compounds used as plasticizers in the manufacture of plastic materials. They can be present in many commonly used products. There seems to be a relationship between exposure to phthalates and the occurrence of metabolic dysfunctions, such as a decrease in glucose tolerance, oxidative stress, loss of beta cells, and a decrease in insulin synthesis. As beta cells play a key role in the onset of type 1 diabetes mellitus (T1DM), we sought to investigate the relationship between exposure to phthalates and the diagnosis of T1DM in prepubertal children. Design concentrations of phthalate metabolites were compared in the urine of a population of prepubertal children with new-onset diabetes, patients with T1DM diagnosed more than 6 months previously, and healthy control children. Although the concentrations of DBP and DiBP metabolites were statistically identical in the new-onset diabetes, diabetes, and control groups, there was a clear trend for higher levels of DiBP metabolites in the children with new-onset diabetes. In our sample, there was a trend for higher levels of DiBP metabolites in children with new-onset diabetes.

Obesity or diet? Levels and determinants of phthalate body burden - A case study on Portuguese children.

In this study we analyzed one of the most comprehensive sets of 21 urinary phthalate metabolites representing exposure to 11 parent phthalates (DEP, DMP, DiBP, DnBP, BBzP, DEHP, DiNP, DiDP, DCHP, DnPeP, DnOP) in first morning urine samples of 112 Portuguese children (4-18 years) sampled in 2014/15. The study population consisted of two groups: group 1 with normal weight/underweight children (N = 43) following their regular diet and group 2 with obese/overweight children (N = 69) following a healthy diet (with nutritional counselling). Most of the metabolites were above the limits quantification (81-100%) except for MCHP, MnPEP and MnOP. Metabolite levels were generally comparable to other recent child and general populations sampled worldwide, confirming the steady decline in exposures to most phthalates. Compared to Portuguese children sampled in 2011/2012, median urinary metabolite levels decreased by approximately 50% for DEHP, DnBP, DiBP and BBzP. Risk assessments for individual phthalates and the sum of the anti-androgenic phthalates did not indicate to attributable health risks, also at the upper percentiles of exposure. In the healthy diet group the median concentration of the DEHP metabolites was significant lower, while all phthalate metabolites except MEP tended to be lower compared to the regular diet group. Multiple log-linear regression analyses revealed significantly lower daily intakes (DIs) for all phthalates in the healthy diet group compared to the regular diet group (geometric mean ratios (gMR) between 0.510-0.618; p ≤ 0.05), except for DEP (gMR: 0.811; p = 0.273). The same analyses with the continuous variable body mass index instead of the diet groups also showed effects on the DIs (gMRs between 0.926-0.951; p ≤ 0.05), however much smaller than the effects of the diet. The results indicate that obese children following a healthy diet composed of fresh and less packaged/processed food can considerably reduce their intake for most phthalates and can have lower phthalate intakes than regular weight/regular diet children.

Micro-QuEChERS extraction coupled to GC-MS for a fast determination of Bisphenol A in human urine.

Bisphenol A (BPA) is considered an endocrine disruptor and public concern over BPA exposure has been raised. Several studies have assessed human exposure to this plasticizer, confirming its ubiquitous presence and highlighting children as a public of special concern. A simple, efficient, cheap and green analytical procedure is reported within this paper. This paper reports, for the first time, the development of a modified Micro-QuEChERS (Quick, Easy, Cheap, Effective, Rugged and Safe) method coupled to gas chromatography-mass spectrometry (GC-MS) as a new strategy for the efficient extraction and determination of Bisphenol A in human urine samples. Several parameters that are known to influence extraction were optimized. Good linearity was achieved at the studied concentration range (1-50µg/L), with a correlation coefficient (R2) of 0.998. The optimized method proved to be accurate (≥74% recovery), reproducible (<11% relative standard deviation) and sensitive for BPA determination (detection limit of 0.13µg/L and quantification limit of 0.43µg/L). The analytical procedure was applied to the analyses of 12 urine samples collected from children living in the North/Center region of Portugal. BPA was detected in all the analyzed samples in concentrations ranging from 1.5µg/L to 48.9µg/L. The proposed methodology is suitable for the determination of BPA in urine samples in the framework of biomonitoring studies and bioanalytical analyses, applying GC-MS detection.

Diagnostic and laboratory test ordering in Northern Portuguese Primary Health Care: a cross-sectional study.

OBJECTIVES: To characterise the test ordering pattern in Northern Portugal and to investigate the influence of context-related factors, analysing the test ordered at the level of geographical groups of family physicians and at the level of different healthcare organisations. DESIGN: Cross-sectional study. SETTING: Northern Primary Health Care, Portugal. PARTICIPANTS: Records about diagnostic and laboratory tests ordered from 2035 family physicians working at the Northern Regional Health Administration, who served approximately 3.5 million Portuguese patients, in 2014. OUTCOMES: To determine the 20 most ordered diagnostic and laboratory tests in the Northern Regional Health Administration; to identify the presence and extent of variations in the 20 most ordered diagnostic and laboratory tests between the Groups of Primary Care Centres and between health units; and to study factors that may explain these variations. RESULTS: The 20 most ordered diagnostic and laboratory tests almost entirely comprise laboratory tests and account for 70.9% of the total tests requested. We can trace a major pattern of test ordering for haemogram, glucose, lipid profile, creatinine and urinalysis. There was a significant difference (P<0.001) in test orders for all tests between Groups of Primary Care Centres and for all tests, except glycated haemoglobin (P=0.06), between health units. Generally, the Personalised Healthcare Units ordered more than Family Health Units. CONCLUSIONS: The results from this study show that the most commonly ordered tests in Portugal are laboratory tests, that there is a tendency for overtesting and that there is a large variability in diagnostic and laboratory test ordering in different geographical and organisational Portuguese primary care practices, suggesting that there may be considerable potential for the rationalisation of test ordering. The existence of Family Health Units seems to be a strong determinant in decreasing test ordering by Portuguese family physicians. Approaches to ensuring more rational testing are needed.

Exposure assessment to bisphenol A (BPA) in Portuguese children by human biomonitoring.

Exposure to bisphenol A (BPA) is known to be widespread and available data suggests that BPA can act as an endocrine disruptor. Diet is generally regarded as the dominant BPA exposure source, namely through leaching to food from packaging materials. The aim of this study was to evaluate the exposure of 110 Portuguese children (4-18 years old), divided in two groups: the regular diet group (n = 43) comprised healthy normal weight/underweight children with no dietary control; the healthy diet group (n = 67) comprised children diagnosed for obesity/overweight (without other known associated diseases) that were set on a healthy diet for weight control. First morning urine samples were collected and total urinary BPA was analyzed after enzymatic hydrolysis via on-line HPLC-MS/MS with isotope dilution quantification. Virtually, all the children were exposed to BPA, with 91% of the samples above the LOQ (limit of quantification) of 0.1 µg/L. The median (95th percentile) urinary BPA levels for non-normalized and creatinine-corrected values were 1.89 µg/L (16.0) and 1.92 µg/g creatinine (14.4), respectively. BPA levels in the regular diet group were higher than in the healthy diet group, but differences were not significant. Calculated daily BPA intakes, however, were significantly higher in children of the regular diet group than in children of healthy diet group. Median (95th percentile) daily intakes amounted to 41.6 (467) ng/kg body weight/day in the regular diet group, and 23.2 (197) ng/kg body weight/day in the healthy diet group. Multiple logistic regression analysis revealed that children in the healthy diet group had 33% lower intakes than children in the regular diet group (OR 0.67; 95% CI 0.51-0.89). For both groups, however, urinary BPA levels and daily BPA intakes were within the range reported for other children's populations and were well below health guidance values such as the European Food Safety Authority (EFSA) temporary tolerable daily intake (t-TDI) of 4 µg/kg body weight/day. In addition, lower daily BPA intakes were more likely linked with the inherent dietary approach rather than with high BMI or obesity.

Adipose tissue dysfunction as a central mechanism leading to dysmetabolic obesity triggered by chronic exposure to p,p'-DDE.

Endocrine-disrupting chemicals such as p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), are bioaccumulated in the adipose tissue (AT) and have been implicated in the obesity and diabetes epidemic. Thus, it is hypothesized that p,p'-DDE exposure could aggravate the harm of an obesogenic context. We explored the effects of 12 weeks exposure in male Wistar rats' metabolism and AT biology, assessing a range of metabolic, biochemical and histological parameters. p,p'-DDE -treatment exacerbated several of the metabolic syndrome-accompanying features induced by high-fat diet (HF), such as dyslipidaemia, glucose intolerance and hypertension. A transcriptome analysis comparing mesenteric visceral AT (vAT) of HF and HF/DDE groups revealed a decrease in expression of nervous system and tissue development-related genes, with special relevance for the neuropeptide galanin that also revealed DNA methylation changes at its promoter region. Additionally, we observed an increase in transcription of dipeptidylpeptidase 4, as well as a plasmatic increase of the pro-inflammatory cytokine IL-1ß. Our results suggest that p,p'-DDE impairs vAT normal function and effectively decreases the dynamic response to energy surplus. We conclude that p,p'-DDE does not merely accumulate in fat, but may contribute significantly to the development of metabolic dysfunction and inflammation. Our findings reinforce their recognition as metabolism disrupting chemicals, even in non-obesogenic contexts.

Exposure to the plasticizer di(2-ethylhexyl) terephthalate (DEHTP) in Portuguese children - Urinary metabolite levels and estimated daily intakes.

Classical ortho-phthalate plasticizers are, due to their endocrine disrupting potency and reproductive toxicity, increasingly replaced by alternative plasticizers. Di(2-ethylhexyl) terephthalate (DEHTP) is one of these substitutes. In this study, we investigated DEHTP exposure in 107 Portuguese children (4-17years old) by analyzing specific DEHTP metabolites in their urine using a newly developed LC-MS/MS method. We could detect the major, specific DEHTP metabolite mono(2-ethyl-5-carboxypentyl) terephthalate (5cx-MEPTP) in 100% of the samples with levels above the limit of quantification in 96% of the samples (median concentration 4.19µg/L; 95th percentile 26.4µg/L; maximum 3400µg/L). Other minor DEHTP metabolites (5OH-MEHTP, 5oxo-MEHTP and 2cx-MMHTP) were detected at lower rates and levels. Daily DEHTP intakes calculated from urinary 5cx-MEPTP levels were generally far below the tolerable daily intake (TDI) of 1000µg/kgbw/d (median 0.67µg/kgbw/d; 95th percentile 6.25µg/kgbw/d; maximum 690µg/kgbw/d). However, for one child the biomarker-derived health-based guidance value (HBM-I value) for 5cx-MEPTP of 1800µg/L was exceeded by about a factor of two. Levels of 5cx-MEPTP and calculated daily DEHTP intakes were higher in normal/under-weight children who nourished on their usual diet compared to overweight/obese children who received nutritional guidance with fresh and unprocessed food (p=0.043 and p<0.001 respectively). This indicates to processed and fatty foodstuff as a major source of DEHTP exposure. Additionally, we found children of lower age having higher DEHTP intakes (p=0.045). Again, foodstuff as a major DEHTP source, together with other child specific DEHTP sources such as mouthing of toys or ingestion of dust might be contributing factors. With the present study, we provide a first data set on the omnipresent DEHTP exposure in children. So far, general levels of DEHTP exposure seem no cause for concern. However, due to the increasing use of DEHTP as an ortho-phthalate substitute, possible increasing exposures in the future should be followed closely.

The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial.

BACKGROUND: The way software for electronic health records and laboratory tests ordering systems are designed may influence physicians' prescription. A randomised controlled trial was performed to measure the impact of a diagnostic and laboratory tests ordering system software modification. METHODS: Participants were family physicians working and prescribing diagnostic and laboratory tests. The intervention group had a modified software with a basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support based on United States Preventive Services Task Force (USPSTF) recommendations. This intervention group was compared with usual software (control group). The outcomes were the number of tests prescribed from those: withdrawn from the basic menu; added to the basic menu; marked with green dots (USPSTF's grade A and B); and marked with red dots (USPSTF's grade D). RESULTS: Comparing the monthly average number of tests prescribed before and after the software modification, from those tests that were withdrawn from the basic menu, the control group prescribed 33.8 tests per 100 consultations before and 30.8 after (p = 0075); the intervention group prescribed 31.3 before and 13.9 after (p < 0001). Comparing the tests prescribed between both groups during the intervention, from those tests that were withdrawn from the basic menu, the intervention group prescribed a monthly average of 14.0 vs. 29.3 tests per 100 consultations in the control group (p < 0.001). From those tests that are USPSTF's grade A and B, intervention group prescribed 66.8 vs. 74.1 tests per 100 consultations in the control group (p = 0.070). From those tests categorised as USPSTF grade D, the intervention group prescribed an average of 9.8 vs. 11.8 tests per 100 consultations in the control group (p = 0.003). CONCLUSIONS: Removing unnecessary tests from a quick shortcut menu of the diagnosis and laboratory tests ordering system had a significant impact and reduced unnecessary prescription of tests. The fact that it was not possible to perform the randomization at the family physicians' level, but only of the computer servers is a limitation of our study. Future research should assess the impact of different tests ordering systems during longer periods. TRIAL REGISTRATION: ISRCTN45427977 , May 1st 2014 (retrospectively registered).

Exposure of Portuguese children to the novel non-phthalate plasticizer di-(iso-nonyl)-cyclohexane-1,2-dicarboxylate (DINCH).

Di-(iso-nonyl)-cyclohexane-1,2-dicarboxylate (DINCH) is used as substitute for high molecular weight phthalate plasticizers such as di-(2-ethylhexyl) phthalate (DEHP) and di-(iso-nonyl) phthalate (DINP). Due to a rapid substitution process we have to assume omnipresent and increasing DINCH exposures. The aim of this study was to evaluate DINCH exposure in 112 children (4-18years old) from Portugal, divided in two groups: 1) normal-/underweight following the usual diet; and 2) obese/overweight but under strict nutritional guidance. First morning urine samples were collected during the years 2014 and 2015. Oxidized DINCH metabolites (OH-MINCH, oxo-MINCH, cx-MINCH) were analyzed after enzymatic hydrolysis via on-line HPLC-MS/MS with isotope dilution quantification. We detected DINCH metabolites in all analyzed samples. Urinary median (95th percentile) concentrations were 2.14µg/L (15.91) for OH-MINCH, followed by 1.10µg/L (7.54) for oxo-MINCH and 1.08µg/L (7.33) for cx-MINCH. We observed no significant differences between the two child-groups; only after creatinine adjustment, we found higher metabolite concentrations in the younger compared to the older children. Median (95th percentile) daily DINCH intakes were in the range of 0.37 to 0.76 (2.52 to 5.61) µg/kg body weight/day depending on calculation model and subpopulation. Body weight related daily intakes were somewhat higher in Group 1 compared to Group 2, irrespective of the calculation model. However, in terms of absolute amounts (µg/day), DINCH intakes were higher in Group 2 compared to Group 1. In regard to age, we calculated higher intakes for the younger children compared to older children, but only with the creatinine-based model. This new data for southern European, Portuguese children adds information to the scarce knowledge on DINCH, confirming omnipresent exposure and suggesting higher exposures in children than adults. Significant sources and routes of exposure have yet to be unveiled. For now, all calculated daily intakes are far below established health benchmark levels (TDI, RfD). However, rapidly increasing exposures have to be expected over the next years.

Application of the QuEChERS method for the determination of organochlorine pesticide residues in Brazilian fruit pulps by GC-ECD.

The Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method was applied to the extraction of 14 organochlorine pesticides (OCPs) residues from commercial fruit pulps available in supermarkets in Fortaleza, Northeastern Brazil. The analyses were carried out by gas chromatography (GC), coupled to an electron-capture detector (ECD), and were confirmed by GC-tandem mass spectrometry (MS). The parameters of the analytical method, such as accuracy, precision, linear range, limits of detection and quantification, were determined for each pesticide. The results showed good linearity (R2 ≥ 0.9916) and the overall average recoveries were considered satisfactory obtaining values between 69 and 110%, RSD of 2-15 %, except for hexachlorobenzene (HCB) in açai, acerola and guava pulp samples. The OCPs were detected in guava (α-HCH; lindane) and soursop (α, ß-HCH isomers) samples. The QuEChERS method and GC-ECD were successfully used to analyze OCPs in commercially available Brazilian fruit pulps and can be applied in routine analytical laboratories.

In vivo and in silico studies to identify mechanisms associated with Nurr1 modulation following early life exposure to permethrin in rats.

The present work was designed to study the mechanisms associated with Nurr1 modulation following early life permethrin (PERM) treatment during rat's life span. Here we demonstrate that PERM exposure in rats, at a dose close to No Observed Adverse Effect Level (NOAEL) for 15days during neonatal brain development leads to its accumulation long after exposure. In striatum from adolescent rats we detected an increase in DNA methyltransferases (DNMTs) such as DNMT1, DNMT3a, Tyrosine hydroxylase, monomeric and aggregated α-synuclein protein levels. Adult rats showed enhanced DNMT3b and α-synuclein aggregation compared to the control group, while with aging a significant decrease in all biomarkers studied was observed. No changes in Nurr1 promoter methylation in adolescent, adult and old rats were found. In silico studies showed clear evidence of a strong binding interaction between PERM and its metabolite 3-phenoxybenzoic acid with the nuclear orphan receptor Nurr1. These findings suggest that an additional interference with the dopaminergic neuron pathway could occur in situ during PERM accumulation in brain. Therefore, Nurr1 modulation in early life PERM-treated rats, depends on age-related adaptive responses in animals.

Patients' estimations of the importance of preventive health services: a nationwide, population-based cross-sectional study in Portugal.

OBJECTIVES: To determine, in the context of primary care preventive health services, the level of importance that Portuguese patients attribute to different preventive activities. DESIGN: Cross-sectional study. SETTING: Primary Healthcare, Portugal. PARTICIPANTS: 1000 Portuguese adults selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. Persons with a cognitive or physical disability that hampered the ability to complete a telephone interview and being a nursing home resident or resident in any other type of collective dwelling were excluded. OUTCOMES: Mean level of importance assigned to 20 different medical preventive activities, using a scale of 1-10, with 1 corresponding to 'no importance for you and your health' and 10 indicating 'very important'. RESULTS: The mean level of importance assigned to medical preventive activity was 7.70 (95% CI 7.60 to 7.80). Routine blood and urine tests were considered the most important, with an estimated mean of 9.15 (95% CI 9.07 to 9.24), followed by female-specific interventions (Pap smear, mammography and gynaecological and breast ultrasounds), with mean importance ranging from 8.45 (95% CI 8.23 to 8.63) for mammography to 8.56 (95% CI 8.36 to 8.76) for Pap smear. Advice regarding alcohol consumption (6.18; 95% CI 5.96 to 6.39) and tobacco consumption (5.99; 95% CI 5.75 to 6.23) were considered much less important. CONCLUSIONS: Our results reveal that Portuguese patients overestimate the importance of preventive medical activities, tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, do not discriminate tests that are important and evidence-based, and seem not be aware of the individualisation of risk. Family physicians should be aware of these optimistic expectations, because these can influence the doctor-patient relationship when discussing these interventions and incorporating personalised risk.

Pyrethroid Pesticide Metabolite in Urine and Microelements in Hair of Children Affected by Autism Spectrum Disorders: A Preliminary Investigation.

The number of children affected by Autism Spectrum Disorders (ASD) is dramatically increasing as well as the studies aimed at understanding the risk factors associated with the development of ASD. Since the etiology of ASD is partly genetic and partly environmental, factors (i.e., heavy metals, pesticides) as well as lifestyle seem to have a key role in the development of the disease. ASD and Control (CTR) children, aged 5-12 years, were compared. Gas chromatography coupled with trap mass detector was used to measure the level of 3-PBA, the main pyrethroid metabolite in urine in a group of ASD patients, while optical emission spectrometry analysis was employed to estimate the level of metals and microelements in hair in a different group of ASD children. The presence of 3-PBA in urine seems to be independent of age in ASD children, while a positive correlation between 3-PBA and age was observed in the control group of the same age range. Urine concentration of 3-BPA in ASD children had higher values than in the control group, which were marginally significant (p = 0.054). Mg results were significantly decreased in ASD with respect to controls, while V, S, Zn, and Ca/Mg were marginally increased, without reaching statistical significance. Results of Principal Component (PC) analysis of metals and microelements in hair were not associated with either age or health status. In conclusion, 3-PBA in urine and Mg in hair were changed in ASD children relative to control ones.

Portuguese Family Physicians' Awareness of Diagnostic and Laboratory Test Costs: A Cross-Sectional Study.

BACKGROUND: Physicians' ability to make cost-effective decisions has been shown to be affected by their knowledge of health care costs. This study assessed whether Portuguese family physicians are aware of the costs of the most frequently prescribed diagnostic and laboratory tests. METHODS: A cross-sectional study was conducted in a representative sample of Portuguese family physicians, using computer-assisted telephone interviews for data collection. A Likert scale was used to assess physician's level of agreement with four statements about health care costs. Family physicians were also asked to estimate the costs of diagnostic and laboratory tests. Each physician's cost estimate was compared with the true cost and the absolute error was calculated. RESULTS: One-quarter (24%; 95% confidence interval: 23%-25%) of all cost estimates were accurate to within 25% of the true cost, with 55% (95% IC: 53-56) overestimating and 21% (95% IC: 20-22) underestimating the true actual cost. The majority (76%) of family physicians thought they did not have or were uncertain as to whether they had adequate knowledge of diagnostic and laboratory test costs, and only 7% reported receiving adequate education. The majority of the family physicians (82%) said that they had adequate access to information about the diagnostic and laboratory test costs. Thirty-three percent thought that costs did not influence their decision to order tests, while 27% were uncertain. CONCLUSIONS: Portuguese family physicians have limited awareness of diagnostic and laboratory test costs, and our results demonstrate a need for improved education in this area. Further research should focus on identifying whether interventions in cost knowledge actually change ordering behavior, in identifying optimal methods to disseminate cost information, and on improving the cost-effectiveness of care.

Motives for requesting an electrocardiogram in primary health care.

The management of requests for diagnostic exams presents its own inherent characteristics in primary health care and reflects the specific nature of the physician-patient relationship. The scope of the study was to identify the reasons for requesting an electrocardiogram (ECG) in primary health care. A cross-sectional study was conducted in an urban region in Portugal, establishing the motives to ask for an ECG consecutively over two years, starting on 01/03/2007 using data retrieved from structured forms filled out by the physician at the moment of requesting the exam. A total of 870 ECGs of 817 patients were included. Symptoms manifested during the patient visit justified 48.5% of the ECGs, and follow-up of cardiovascular risk factors motivated 25.2%. A global health examination accounted for 22.8% of the requests. Multivariate analysis showed that the presence of symptoms (p < 0.001), presence of any cardiovascular risk factor (p = 0.002), hypertension (p < 0.001), diabetes (p = 0.002), and urgency (p < 0.001) were the main factors associated with the requests. The requests for electrocardiograms are predominantly for clinical reasons as a result of patients symptoms. The integration of expectations and beliefs of the patients is present in the decision-making process.