Social prescribing for older adults in mainland Portugal: Perceptions and future prospects.

Background: In order to address health inequalities, which have been exacerbated by the COVID-19 pandemic, and promote older adults' quality of life, it is necessary to explore non-medical approaches such as social prescribing. Social prescribing is a person-centered approach that allows health professionals to refer patients to services provided by the social and community sectors. This study aimed to explore older adults' perceptions of social prescribing in mainland Portugal and to identify factors associated with these perceptions, providing insights for future implementation strategies. Methods: A cross-sectional study was conducted with 613 older adults aged 65 to 93. Participants' sociodemographic, economic, and health characteristics were assessed, along with their perceptions of social prescribing's benefits and activity interest. Results: Over 75% of respondents agreed that social prescribing would benefit the health system and their community. Most participants (87.7% and 89.7%, respectively) thought that activities like personal protection and development activities and cultural enrichment would be particularly relevant to them. Factors such as marital status, education, health status, and pain/discomfort levels influenced the perceived relevance of these activities. Conclusion: This study reveals that older adults in mainland Portugal are open to social prescribing and suggests that tailored interventions considering individual preferences and characteristics can lead to more effective implementation and equal access to social prescribing. Further research and policy efforts should focus on integrating social prescribing into the healthcare system to support healthy aging in Portugal.

Active aging awareness and well-being among older adults in Portugal.

Objective: This study aims to assess the active aging awareness of older adults in mainland Portugal and their levels of overall well-being and to identify social and health-related factors. Methods: A cross-sectional study was conducted with a representative sample of 613 older adults, aged 65 or older, who participated in the PROKnos - Knowing Social Prescribing needs of the elderly study in Portugal. The questionnaire consisted of the Active Ageing Awareness Questionnaire and the World Health Organization - Five Well-Being Index, as well as sociodemographic, economic, and health status questions. Correlation coefficients, t-tests for independent samples, and one-way ANOVA were used to explore potential associations between variables. Results: The active aging awareness levels were significantly higher for women (p = 0.031), and those who were younger (p = 0.011), more educated (p < 0.001), had a better financial situation (p < 0.001), and had better health (p < 0.001). The same pattern was found for well-being, except in relation to gender, as men had higher levels (p = 0.016). These variables were found to be correlated. Discussion: Even though active aging is an important strategy to implement, it is indispensable to consider the perceptions and conditions that need to be in place before that. This study reveals that several social and health-related factors are associated with well-being and active aging awareness, as well as the differences between groups that exist in mainland Portugal in relation to that. This emphasizes how vital it is to address social inequalities in active aging efforts, which are not necessarily uncovered when only considering actual active aging measures.

Mental Health and Well-Being of Migrant Populations in Portugal Two Years after the COVID-19 Pandemic.

In Portugal, like in other European countries, the COVID-19 pandemic aggravated the risk of poverty and social exclusion faced by migrants. This study aimed to assess mental health and well-being, and their social determinants, among Brazilian and Cape Verdean immigrant populations two years after the COVID-19 pandemic while exploring the role of positive psychological factors such as resilience and perceived social support. We conducted a cross-sectional survey combining online and face-to-face questionnaires for data collection between February and November 2022 on dimensions of mental health considered potentially relevant to the post-pandemic context: psychological distress, anxiety, and depression. Overall, 604 immigrants were included (322 Brazilian and 282 Cape Verdean); 58.5% of those surveyed were women and 41.5% were men. The results revealed that gender (being a woman) was associated with both psychological distress and depression, higher education was associated with anxiety, and that, for the three mental health dimensions under analysis, the perception of discrimination and resilience were negative and positive predictors, respectively. Findings can inform the design and implementation of relevant public mental health promotion programs with a focus on equity targeted to the general population. Such programs would help to address the psychological and social impacts of this long-term, insidious global pandemic that has challenged governments, health care systems, health care professionals, individuals, families, and communities worldwide.

Health Literacy among Older Adults in Portugal and Associated Sociodemographic, Health and Healthcare-Related Factors.

Although the health literacy level of the general population was described recently, little is known about its specific levels among older adults in Portugal. Therefore, this cross-sectional study aimed to investigate the levels of health literacy demonstrated by older adults in Portugal and explore associated factors. Using a randomly generated list of telephone numbers, adults aged 65 years or more living in mainland Portugal were contacted in September and October 2022. Sociodemographic, health and healthcare-related variables were collected, and the 12-item version of the European Health Literacy Survey Project 2019-2021 was used to measure health literacy. Then, binary logistic regression models were used to investigate factors associated with limited general health literacy. In total, 613 participants were surveyed. The mean level of general health literacy was (59.15 ± 13.05; n = 563), whereas health promotion (65.82 ± 13.19; n = 568) and appraising health information (65.16 ± 13.26; n = 517) were the highest scores in the health literacy domain and the dimension of health information processing, respectively. Overall, 80.6% of respondents revealed limited general health literacy, which was positively associated with living in a difficult household financial situation (4.17; 95% Confidence Interval (CI): 1.64-10.57), perceiving one's own health status as poorer (7.12; 95% CI: 2.02-25.09), and having a fair opinion about a recent interaction with primary healthcare services (2.75; 95% CI: 1.46-5.19). The proportion of older adults with limited general health literacy in Portugal is significant. This result should be considered to inform health planning according to the health literacy gap of older adults in Portugal.

Exploring the Effects of the COVID-19 Pandemic on Mental Health and Well-Being of Migrant Populations in Europe: An Equity-Focused Scoping Review.

The pandemic is aggravating health inequalities, particularly mental health inequalities, while revealing the social determinants of these inequalities, including migration as a social determinant that mediates the interaction of social, economic, cultural, institutional, and structural factors with health indicators. Therefore, it is of most relevance to identify the multiple interconnected factors that influence the mental health and well-being of migrant populations. A scoping review was developed to map the research performed in this area and to identify any gaps in knowledge, following the PRISMA extension for scoping reviews. MEDLINE, Scopus, and WHO Global Health research databases on COVID-19 were searched from January 2020 to October 2021. The review followed the inclusion criteria Population/Concept/Context (PCC): Population-Adult International migrants (including refugees, asylum seekers, and undocumented migrants); Concept-determinants of (and factors influencing) mental health and well-being; Context-COVID-19 anywhere in the world. Of the sixty-five selected studies, eleven were from European countries and were the focus of this review with special attention to health inequalities experienced by migrants in Europe. The results cover a diversity of themes related to the effects of COVID-19 on the mental health of migrants (country-level environmental factors, social determinants of mental health, mental health indicators and outcomes), responses (such as solidarity and resilience), populations, and study methods. The evidence found can inform recommendations and interventions focused on health promotion and mitigation of the inequalities accentuated by the pandemic.

Are beliefs and attitudes about COVID-19 associated with self-perceived changes in food consumption? Results from a nationwide survey during lockdown.

This study aimed to understand how beliefs and attitudes regarding COVID-19 are associated with self-perceived changes in food consumption during lockdown between March 19 and May 2, 2020. We conducted a cross-sectional study with a non-probabilistic weighted sample of the Portuguese population. Data were collected using an online survey and telephone interviews. The association between agreement with sentences about food and COVID-19 and perceived changes in food consumption were assessed by multinomial logistic regression models. Overall, 5858 citizens were included, with a mean age of 38.2 (17.3) years. Exclusive agreement with the belief "SARS-CoV-2 can be transmitted by food" (27.5%) was associated with decreased odds of perceived positive changes (e.g., increased consumption of fruit and vegetables). Agreement only with the attitudinal sentence "I started to consume foods that may protect against COVID-19" (11.9%) was associated with positive perceived consumption changes (e.g., increasing fruit and vegetables, and decreasing soft drinks and snacks). Cumulative agreement (with both sentences; 10.6%) was also associated with mostly positive food consumption changes. Specific beliefs and attitudes regarding COVID-19 and food are associated with self-perceived changes in food consumption. Longitudinal research is needed to understand how beliefs and/or attitudes about the role of food in infectious diseases act as determinants of eating behavior modification.

Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways.

The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.

MAternal Mental Health in the WORKplace (MAMH@WORK): A Protocol for Promoting Perinatal Maternal Mental Health and Wellbeing.

Women are exposed to increased burden of mental disorders during the perinatal period: 13-19% experience postpartum depression. Perinatal psychological suffering affects early mother-child relationship, impacting child's emotional and cognitive development. Return-to-work brings additional vulnerability given the required balance between parenting and job demands. The MAternal Mental Health in the WORKplace (MAMH@WORK) project aims to develop and evaluate the effectiveness of a brief and sustainable intervention, promoting (a) maternal mental health throughout pregnancy and first 12 months after delivery, and (b) quality of mother-child interactions, child emotional self-regulation, and cognitive self-control, while (c) reducing perinatal absenteeism and presenteeism. MAMH@WORK is a three-arm randomized controlled trial. A short-term cognitive-behavioral therapy-based (CBT-based) psychoeducation plus biofeedback intervention will be implemented by psychiatrists and psychologists, following a standardized procedure manual developed after consensus (Delphi method). Participants (n = 225, primiparous, singleton pregnant women at 28-30 weeks gestational age, aged 18-40 years, employed) will be randomly allocated to arms: CBT-based psychoeducation intervention (including mindfulness); psychoeducation plus biofeedback intervention; and control. Assessments will take place before and after delivery. Main outcomes (and main tools): mental health literacy (MHLS), psychological wellbeing (HADS, EPDS, KBS, CD-RISC, BRIEF COPE), quality of mother-child interaction, child-mother attachment, child emotional self-regulation and cognitive self-control (including PBQ, Strange Situation Procedure, QDIBRB, SGS-II, CARE-Index), job engagement (UWES), and presenteeism. Intention-to-treat and per-protocol analyses will be conducted; Cohen's d coefficient, Cramer's V and odds ratio will be used to assess the effect size of the intervention. MAMH@WORK is expected to contribute to mental health promotion during the perinatal period and beyond. Its results have the potential to inform health policies regarding work-life balance and maternal mental health and wellbeing promotion in the workplace.

Looking Ahead: Health Impact Assessment of Front-Of-Pack Nutrition Labelling Schema as a Public Health Measure.

This study aimed to describe the underlying process, used methods and major recommendations emerging from a comprehensive and prospective health impact assessment of the endorsement of a front-of-pack nutrition labelling (FOP-NL) system by the Portuguese health authorities. A mixed-methods approach was used to gather information on the impact of four FOP-NL schemes on consumers' selection of food products according to the perception of their nutritional quality, combining a systematic literature review, focus groups (FG), in-depth individual interviews, and an open-label crossover randomized controlled study. The relevance of FOP-NL as a public health promotion policy has emerged as a consensual idea among either FGs' participants (i.e., consumers and experts), or interviewed stakeholders. Although all of the evaluated FOP-NLs result better than no system on promoting the choice of the healthiest product, the effectiveness of easy-to-interpret FOP-NL among vulnerable groups raised concerns related to the need of integrating specific nutritional information to promote a better self-management of chronic diseases, and related to the level of literacy of consumers, which could impair the usage of FOP-NL. Educational campaigns addressing skills to use FOP-NL is recommended. Furthermore, a monitoring strategy should be considered to evaluate the long-term effectiveness of this policy in promoting healthier food choices, and in reducing diet-related non-communicable diseases burden.

I-DECIDE: A Social Prescribing and Digital Intervention Protocol to Promote Sexual and Reproductive Health and Quality of Life among Young Cape Verdeans.

Cape Verdean governments have intensified the investment on the National Reproductive Health Program, aiming to provide universal and qualified services, especially to the youngest people. Nevertheless, data suggest that some health challenges remain in this group (e.g., high rates of early/unplanned pregnancies, illegal abortions, sexual risk behaviors). In this paper, we present a protocol of a community-based social prescribing and digital intervention to promote wellbeing and quality of life across the life course of young Cape Verdeans, with a specific focus on Sexual and Reproductive Health (SRH) related behaviors. The intervention program, to be developed in three years, will follow an Intervention Mapping approach, namely regarding needs assessment and study's protocol. The program's implementation and evaluation will occur simultaneously. The main expected result is the development of a sustainable training program implemented in coproduction with Cape Verdeans from Mindelo (in São Vicente island), with replicable potential in other Cape Verdean regions. The intervention will contribute to SRH-related literacy through the digital health literacy materials and to quality of life across the young's life course.

Impact of different front-of-pack nutrition labels on online food choices.

Front-of-pack nutrition labels (FOP-NL) are efficient tools for increasing consumers' awareness of the nutritional quality of food products, prompting healthier food choices. The main goal of this study was to evaluate the impact of four FOP-NL schemes - Traffic Light label (TL), Guideline Daily Amounts (%GDA), Nutri-Score (NS) and Health Star Rating (HSR) - on consumers' selection of food products according to perceived nutritional quality. A cross-sectional open-label crossover randomized controlled study was carried out among Portuguese consumers. A web-based questionnaire was used to assess participants' a) preferences regarding FOP-NLs and b) capacity to select healthy products in a food selection task using the information from FOP-NL schemes. When performing the selection task, participants had the option to indicate that they could not decide simply based on the presented FOP-NL (requiring more information). Overall, 357 adults participated in the study. Regarding consumers' preferences, TL received the most favorable responses, while NS received the fewest. All FOP-NLs performed better than the no-nutritional label control condition in the food selection task. The highest proportion of correct choices was obtained for TL (72.3%), followed by HSR (70.9%), %GDA (70.0%) and NS (62.2%), though no significant differences were found among FOP-NLs. Percentages of respondents indicating not being able to answer due to lack of information affected the proportion of correct choices, with 10.3% for TL, 12.9% for %GDA, 14.6% for HSR, and 25.8% for NS, indicating they were unable to choose without additional information. Although no particular FOP-NL system stood out as the most significantly effective, TL was the most preferred by Portuguese adults. Long-term real-world evidence is necessary to assess the impact of FOP-NL systems on individuals' food choices.

Geriatric Assessment of the Portuguese Population Aged 65 and Over Living in the Community: The PEN-3S Study.

INTRODUCTION: As populations live longer, they also aim to live better. A crucial step for this is to improve the understanding about older adults' physical and psychological health. Therefore, the aim of the present study was to characterise the Portuguese population over-65 regarding nutritional status, cognitive function, functional status, symptoms of depression, and loneliness, by sex and age groups. MATERIAL AND METHODS: Cross-sectional study including a nationally representative sample of community-dwelling adults aged 65 and over. Trained interviewers collected data face-to-face on demographic and socioeconomic characteristics, health status, nutritional status, cognitive function, functional status for activities of daily living, symptoms of depression, and loneliness feelings. Complex sample procedures were used in the statistical analysis. RESULTS: Overall, 1120 community-dwellers (49.0% women, 21.3% aged ≥ 85) participated in the study. The estimated prevalence of risk of malnutrition was 16.4% (95% confidence interval: 13.3 - 19.9), while 17.7% (95% confidence interval: 12.8 - 23.9) were cognitively impaired, and 28.5% (95% confidence interval: 23.7 - 33.8) presented limitations to perform daily living activities. Moreover, 23.5% (95% confidence interval: 19.7 - 27.7) presented symptoms of depression and 13.6% (95% confidence interval: 10.6 - 17.1) reported loneliness feelings. These conditions were more prevalent among women, and generally more frequent in the oldest individuals (≥ 85). DISCUSSION: Risk of malnutrition, cognitive impairment, functional limitations, depression and loneliness were moderately frequent, which may justify screening and preventive actions at a community level. CONCLUSION: This study contributed to a national characterisation of the health of older adults, that may inform policies and interventions targeted at the needs of the Portuguese aging population.

Introdução: Com o aumento de longevidade importa também viver melhor. Um passo crucial neste sentido é aumentar o conhecimento sobre a saúde física e psicológica da população mais velha. O objetivo deste estudo foi caraterizar o estado nutricional, função cognitiva, estado funcional, sintomas de depressão, e solidão dos Portugueses com 65 ou mais anos, por sexo e grupo etário. Material e Métodos: Estudo transversal incluindo uma amostra representativa nacional de indivíduos ≥ 65 anos a residir na comunidade. Entrevistadores treinados recolheram dados face-a-face sobre caraterísticas demográficas e socioeconómicas, estado de saúde, estado nutricional, função cognitiva, estado funcional (atividades instrumentais da vida diária), sintomas de depressão, e sentimentos de solidão. Procedimentos adequados a amostras complexas foram utilizados na análise estatística. Resultados: No total participaram 1120 indivíduos (49,0% mulheres; 21,3% ≥ 85 anos). A prevalência estimada de risco de malnutrição foi 16,4% (intervalo de confiança: 95%: 13,3 ­ 19,9), enquanto que 17,7% (intervalo de confiança: 95%: 12,8 ­ 23,9) apresentavam função cognitiva comprometida, e 28,5% (intervalo de confiança: 95%: 23,7 ­ 33,8) tinham limitações para realizar atividades da vida diária. Adicionalmente, 23,5% (intervalo de confiança: 95%: 19,7 ­ 27,7) apresentavam sintomas de depressão e 13,6% (intervalo de confiança: 95%: 10,6 ­ 17,1) relatavam sentimentos de solidão. Estas condições eram mais prevalentes nas mulheres, e geralmente mais frequentes nos mais velhos (≥ 85 anos). Discussão: Risco de malnutrição, comprometimento cognitivo, limitações funcionais, depressão e solidão são moderadamente frequentes, justificando rastreios e ações preventivas de base comunitária. Conclusão: Este estudo contribuiu para a caraterização da saúde dos Portugueses com mais de 65 anos, o que pode suportar políticas e intervenções dirigidas às necessidades da população mais velha.

Association between living setting and malnutrition among older adults: The PEN-3S study.

OBJECTIVES: Malnutrition is frequent among older adults, especially those living in nursing homes, but the association between residential setting and nutritional status is controversial. The aim of this study was to examine the association between living setting (nursing home versus community) and malnutrition while adjusting for demographic, socioeconomic, health-related, and psychosocial factors. METHODS: This cross-sectional study included a randomly selected representative sample of Portuguese adults ≥65 y of age. Interviewers collected data regarding demographic and socioeconomic characteristics, nutritional status, physical activity, energy intake, cognitive function, self-reported general health, functional status, symptoms of depression, and loneliness. Logistic regression models were used to estimate the association between residential setting and malnutrition. RESULTS: Participants were 1186 nursing home residents (72.8% women, 49.2% ≥85 y of age) and 1120 community dwellers (49% women, 21.3% ≥85 y of age). Following Mini Nutritional Assessment (MNA®) criteria, 29.6% of nursing home residents and 14.1% of community dwellers were at risk of malnutrition, whereas 2.3% and 0.3%, respectively, were malnourished. The living setting was not significantly associated with malnutrition after adjusting for functional status, symptoms of depression, and feelings of loneliness (odds ratio, 1.03; 95% confidence interval, 0.67-1.58). CONCLUSIONS: Risk of malnutrition and malnutrition are more prevalent among nursing home residents than community dwellers. Physical (functional status) and mental health (symptoms of depression and loneliness) seems more relevant to nutritional status than residential setting by itself. These findings should be taken into account when designing public health policies to tackle malnutrition among older adults.

Effectiveness of interpretive front-of-pack nutritional labelling schemes on the promotion of healthier food choices: a systematic review.

AIMS: Interpretive front-of-package nutrition labelling can contribute to healthier food habits. This systematic review aimed to examine the effectiveness of interpretive front-of-package nutrition labelling schemes on consumers' food choices, namely at the moment of food purchase, and to analyse if this potential front-of-package nutrition labelling's effect varies according to different socioeconomic groups. METHODS: Electronic databases (Cochrane Library, PubMed, Scopus, and Web of Science) search was performed to identify peer-reviewed articles describing longitudinal studies evaluating the effect of front-of-package nutrition labelling schemes on consumers' food choices, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity 2012 Extension guidelines. No publication-period or language restrictions were applied. PROGRESS-Plus framework was used to report if and how socioeconomic factors were considered in analyses of front-of-package nutrition labelling-related interventions' effect. RESULTS: Nine studies were selected for narrative synthesis (seven randomized controlled trials and two cross-over trials). When compared with no-interpretive-label conditions, front-of-package nutrition labelling showed a positive impact for nutritional content understanding, healthiness perception of products, selection of products with better nutritional quality, and purchase intention. However, there is no robust evidence of superiority of a specific front-of-package nutrition labelling scheme's effect, neither on consumers' understanding of nutritional content nor on food choices. An evaluation of the studies following the PROGRESS-Plus framework revealed that socioecononomic status and education were the most frequently used dimensions, when assessing the effect of interpretative front-of-pack nutrition labels. More evidence is necessary to determine the role of front-of-pack nutrition labels in decreasing inequalities between different population subgroups, namely among the most vulnerable subgroups, on the promotion of healthy food choices. CONCLUSION: Well controlled longitudinal studies, following a real-world evidence approach, are needed to clarify front-of-package nutrition labelling's impact on consumers' food choices, namely at purchase points, taking into account the most vulnerable population subgroups, such as those with lower literacy and/or financial resources.

Understanding the relationship between BMI and sexual dysfunction: Can DSM-5 shed light into this topic? / Entender la relación entre el IMC y la disfunción sexual: ¿puede el DSM-5 arrojar nueva luz sobre este tema?

INTRODUCTION: The links between body weight and sexuality, notably sexual dysfunction (SD), are intricate and not yet fully understood. A more individual-focused evaluation of sexual difficulties, as recently provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), contributes to improve precision in SD diagnosis and has the potential to advance our knowledge on the association between body weight and SD. OBJECTIVES: To identify gender differences in sexual behaviors and SD among Portuguese men and women within different classes of body mass index (BMI); and to explore the association between BMI and SD by using the new DSM-5 criteria. MATERIAL AND METHODS: Face-to-face interviews followed by self-completed questionnaires of primary healthcare users in Portugal (n=323). Data on sociodemographic variables, BMI, sexual behaviors and SD were collected. DSM-5 criteria were used to assess sexual dysfunction. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) for men and women, respectively, were used for comparison purposes. RESULTS: Overweight and obese women reported less sexual partners, less satisfaction with sexual frequency and rated sexual life as less important. These differences were not found among men. Normal weight men and women had a higher score of IIEF and FSFI, respectively, than those overweight and obese. No significant effects of BMI scale on SD following DMS-5 were detected. CONCLUSIONS: Women's sexual function is more impacted by BMI than men's. Individual-orientated approaches, as proposed in DSM-5, may allow a better understanding on the relation between body size and sexuality in both genders

INTRODUCCIÓN: La relación entre el peso corporal y la sexualidad, en particular la disfunción sexual (DS), es compleja y aún no se entiende por completo. Una evaluación de las dificultades sexuales más centrada en el individuo, como la recientemente proporcionada por el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5), contribuye a mejorar la precisión en el diagnóstico de la DS y tiene el potencial para avanzar en el conocimiento sobre la asociación entre el peso corporal y la DS. OBJETIVO: Identificar diferencias de género en conductas sexuales y DS entre varones y mujeres portuguesas con diferentes clases de índice de masa corporal (IMC), y explorar la asociación entre IMC y DS utilizando los nuevos criterios del DSM-5. MATERIAL Y MÉTODOS: Entrevistas cara a cara con usuarios de atención primaria de salud en Portugal (n=323), seguidas de cuestionarios autocompletados. Se recogieron datos sobre variables sociodemográficas, IMC, conductas sexuales y DS. Los criterios del DSM-5 se utilizaron para evaluar la DS. El Índice Internacional de Función Eréctil (IIEF) y el Índice de Función Sexual Femenina (IFSF) se utilizaron con fines comparativos, para varones y mujeres, respectivamente. RESULTADOS: Las mujeres con sobrepeso y obesidad comunicaron menos parejas sexuales, menor satisfacción con la frecuencia sexual y calificaron la vida sexual como menos importante. Estas diferencias no se encontraron entre los varones. Los varones y mujeres de peso normal tuvieron una puntuación más alta de IIEF y IFSF, respectivamente, que los varones y las mujeres con sobrepeso y obesidad. No se detectaron efectos importantes de la escala del IMC en la DS según el DSM-5. CONCLUSIÓN: La función sexual de las mujeres está más afectada por el IMC que la de los varones. Los enfoques orientados al individuo, como se propone en el DSM-5, pueden permitir una mejor comprensión de la relación entre el peso corporal y la sexualidad en ambos sexos

Fertility, Migration and Acculturation (FEMINA): a research protocol for studying intersectional sexual and reproductive health inequalities.

BACKGROUND: The existing knowledge on the interplay between reproductive and sexual health, migration and acculturation is recent and inconsistent, particularly on the sociocultural motives and constraints regarding fertility. Therefore, sexual and reproductive health (SRH) surveys are needed to provide accurate and comparable indicators to identify and address SRH inequalities, with specific focus on under researched aspects, such as the interrelation between migration and gender. FEMINA (FErtility, MIgratioN and Acculturation) aims to investigate intersectional SRH inequalities among Cape Verdean immigrant and Portuguese native families and how they impact on fertility in Portugal. This study will use a comprehensive approach exploring simultaneously the components of SRH, namely regarding identities, perceptions and practices of both women and men among lay people and relevant experts and stakeholders. The project has three main goals: 1) to identify social determinants of SRH among Cape Verdean immigrant and Portuguese native men and women of reproductive age; 2) to gain understanding of the diversity of the sexual and reproductive experiences and expectations of Cape Verdean immigrant and Portuguese native men and women of reproductive age, considering the singularities of their migratory, social and family dynamics; and 3) to produce recommendations for policy makers, employers and service providers on how to better address the SRH needs of Portuguese-born and immigrant populations. METHODS: The study will address these goals using a mixed methods approach, including: a cross-sectional telephone survey with a probabilistic sample of 600 Cape Verdean immigrant and 600 Portuguese native women and men (women aged 18 to 49 and men aged 18 to 54), residents of the Greater Lisbon Area; a qualitative research through in-depth interviews with a subsample of 30 Cape Verdean immigrants and 30 Portuguese native men and women; and a Delphi technique for finding consensus on good practices in SRH for the entire population with a special emphasis on immigrants, namely extra-EU migrants. DISCUSSION: Data will be used to produce a comprehensive set of indicators to monitor SRH in Portugal, to foster a greater understanding of its specificities and challenges to policy and decision makers, and to provide targeted recommendations to promote inclusive and migrant sensitive SRH services.

Understanding the relationship between BMI and sexual dysfunction: Can DSM-5 shed light into this topic?

INTRODUCTION: The links between body weight and sexuality, notably sexual dysfunction (SD), are intricate and not yet fully understood. A more individual-focused evaluation of sexual difficulties, as recently provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), contributes to improve precision in SD diagnosis and has the potential to advance our knowledge on the association between body weight and SD. OBJECTIVES: To identify gender differences in sexual behaviors and SD among Portuguese men and women within different classes of body mass index (BMI); and to explore the association between BMI and SD by using the new DSM-5 criteria. MATERIAL AND METHODS: Face-to-face interviews followed by self-completed questionnaires of primary healthcare users in Portugal (n=323). Data on sociodemographic variables, BMI, sexual behaviors and SD were collected. DSM-5 criteria were used to assess sexual dysfunction. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) for men and women, respectively, were used for comparison purposes. RESULTS: Overweight and obese women reported less sexual partners, less satisfaction with sexual frequency and rated sexual life as less important. These differences were not found among men. Normal weight men and women had a higher score of IIEF and FSFI, respectively, than those overweight and obese. No significant effects of BMI scale on SD following DMS-5 were detected. CONCLUSIONS: Women's sexual function is more impacted by BMI than men's. Individual-orientated approaches, as proposed in DSM-5, may allow a better understanding on the relation between body size and sexuality in both genders.

Gender differences in psychosocial determinants of self-perceived health among Portuguese older adults in nursing homes.

Objectives: Self-perceived health declines with age, varies by gender and is a predictor of mortality, morbidity, physical and psychological functioning. However, gender differences in health and illness perception are complex and not yet fully understood. This study aimed to explore gender-related differences in psychosocial determinants of self-perceived health among older adults living in nursing homes. Method: Nationwide face-to-face survey of the Portuguese population aged 65 and over. A representative sample of nursing homes residents was obtained through a multistage cluster random sampling of nursing homes, stratified by main Portuguese administrative regions (NUTS II). Results: Overall, 1186 nursing homes residents voluntarily enrolled in this study (participation rate, 93%) and a total of 515 participants (70.1% women) were considered to have adequate cognitive functioning to answer all questionnaires. A significant association between self-rated health and gender was found: 90.6% of all women (95% CI: 85.7-93.9) and 82.3% of all men (95% CI: 72.9-88.9) rated their health as less than good (p = 0.023). Gender-stratified analyses showed differences in psychosocial determinants of self-perceived health. While symptoms of depression and loneliness feelings were the major psychosocial determinants of poor self-perceived health among women, age and subjective financial well-being were the only determinants among men. Conclusion: Factors associated with perceived health, as representative of healthy ageing, were identified by gender, leading to future avenues for fruitful investigation. The acknowledgement of interpersonal and socioeconomic factors that determine the experience of ageing at a national level is crucial to improve the health of elders.

Malnutrition among older adults living in Portuguese nursing homes: the PEN-3S study.

OBJECTIVE: To characterise the nutritional status and to identify malnutrition-associated variables of older adults living in Portuguese nursing homes. DESIGN: Cross-sectional study. Data on demographic and socio-economic characteristics, self-reported morbidity, eating-related problems, nutritional status, cognitive function, depression symptoms, loneliness feelings and functional status were collected by trained nutritionists through a computer-assisted face-to-face structured interview followed by standardised anthropometric measurements. Logistic regression was used to identify factors associated with being at risk of malnutrition/malnourished. SETTING: Portuguese nursing homes. SUBJECTS: Nationally representative sample of the Portuguese population aged 65 years or over living in nursing homes. RESULTS: A total of 1186 individuals (mean age 83·4 years; 72·8 % women) accepted to participate. According to the Mini Nutritional Assessment, 4·8 (95 % CI 3·2, 7·3) % were identified as malnourished and 38·7 (95 % CI 33·5, 44·2) % were at risk of malnutrition. These percentages increased with age and were significantly higher for women. Logistic regression showed (OR; 95 % CI) that older adults reporting no or little appetite (6·5; 2·7, 15·3), those revealing symptoms of depression (2·6; 1·6, 4·2) and those who were more dependent in their daily living activities (4·7; 2·0, 11·1) were also at higher odds of being malnourished or at risk of malnutrition. CONCLUSIONS: Malnutrition and risk of malnutrition are prevalent among nursing home residents in Portugal. It is crucial to routinely screen for nutritional disorders, as well as risk factors such as symptoms of depression and lower functional status, to prevent and treat malnutrition.