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Determinants of frequent use of open consultations: a study on patient demographics, chronic conditions, and utilization patterns in primary care

Wed, 01 Jan 2025 00:00:00 GMT

Title: Determinants of frequent use of open consultations: a study on patient demographics, chronic conditions, and utilization patterns in primary care Abstract: In Portugal, open consultations (OCs) in primary health care address urgent medical needs, constituting 40–50% of family doctor activity. Frequent attenders (FAs), often presenting nonacute issues, significantly contribute to health care overuse. This study aimed to identify factors associated with frequent OC use in a primary health care unit during 2022. A retrospective cross-sectional analysis was conducted on 4,269 adult patients, with frequent attendance defined as four or more consultations (≥90th percentile). Sociodemographic and clinical factors, including age, sex, employment, chronic conditions, and multimorbidity, were examined using binomial logistic regression. FAs (n = 570, 13.4%) accounted for 36.2% of all consultations. Significant associated variables included female sex (OR = 1.417), economic insufficiency (OR = 1.323), and multimorbidity (OR = 1.678). Conditions such as musculoskeletal (OR = 2.146), psychological (OR = 2.040), and neurological (OR = 1.550) disorders were strongly linked to frequent attendance. While FAs represent a minority of patients, their disproportionate use of OC services underscores the need for targeted interventions, such as individualized care plans and resource optimization, to balance demand and availability. These findings highlight critical areas for policy and practice to enhance health care efficiency.

NUTLY: um instrumento baseado em fotografias para medição da literacia nutricional

Mon, 01 Jan 2024 00:00:00 GMT

Title: NUTLY: um instrumento baseado em fotografias para medição da literacia nutricional Abstract: A literacia nutricional é um componente fulcral da literacia em saúde, e tem sido associada positivamente à prática de uma alimentação saudável. Os instrumentos atuais de medição deste conceito têm a desvantagem de depender bastante da capacidade dos participantes para ler ou fazer cálculos matemáticos, dificultando a sua aplicação em indivíduos com baixa escolaridade. Avaliam apenas conhecimentos teóricos, pelo que também não refletem diretamente a relação entre estes conhecimentos e a capacidade de fazer escolhas alimentares adequadas. O projeto NUTLY pretendeu ultrapassar algumas destas limitações, através do desenvolvimento de um instrumento de medição da literacia nutricional baseado em fotografias, e validação para aplicação na população adulta residente em Portugal. O instrumento NUTLY tem como premissa a comparação de alimentos com diferentes perfis nutricionais, focando-se em conhecimentos e competências com relevância prática para a escolha alimentar. O objetivo do presente artigo é divulgar esta ferramenta entre profissionais de saúde a exercer funções em Portugal, bem como discutir as suas principais potencialidades de aplicação (nomeadamente nos contextos da educação alimentar, saúde pública, investigação científica e nutrição clínica).

Adesão ao Padrão Alimentar Mediterrânico, consumo de alimentos ultraprocessados e estudo dos fatores associados: resultados do Projeto UltraTeen

Mon, 01 Jan 2024 00:00:00 GMT

Title: Adesão ao Padrão Alimentar Mediterrânico, consumo de alimentos ultraprocessados e estudo dos fatores associados: resultados do Projeto UltraTeen Abstract: Introdução: Os hábitos alimentares são uma das principais causas modificáveis de doenças crónicas não transmissíveis. A Dieta Mediterrânica é conhecida por ser um padrão alimentar protetor da saúde e sustentável. Nas últimas décadas, Portugal, tem-se distanciado deste padrão alimentar e aumentado o consumo de alimentos ultraprocessados. Objetivos: Avaliar a adesão ao Padrão Alimentar Mediterrânico, o consumo de alimentos ultraprocessados e fatores associados, em crianças e adolescentes. Metodologia: Estudo transversal, observacional descritivo. Aplicou-se um questionário, que incluía a versão portuguesa do Índice KIDMED e um Índice de consumo de alimentos ultraprocessados construído para este projeto, a uma amostra de conveniência de crianças e adolescentes com idades entre os 10 e os 19 anos. Os dados foram tratados e analisados no programa estatístico SPSS® com um nível de confiança de 95%. Resultados: A amostra incluiu 506 participantes, sendo 54,3% do sexo feminino, com uma idade média de 14,1 anos (dp = 2,5). A adesão ao Padrão Alimentar Mediterrânico correlacionou-se com o consumo de alimentos ultraprocessados (r = 0,447; p < 0,001). Verificou-se uma elevada adesão ao Padrão Alimentar Mediterrânico por 47,8% dos participantes, média adesão por 47,2% e baixa adesão por 4,9%, sendo mais elevada nos indivíduos fisicamente ativos (η2p = 0,012; p = 0,021), nos que têm hábitos de sono à semana adequados (η2p = 0,009; p = 0,045) e nos mais novos (r = -0,112; p = 0,003). O consumo de alimentos ultraprocessados revelou uma pontuação média de 21,8 (dp = 4,8), sendo o sexo masculino (η2p = 0,031; p < 0,001) e os que passam mais tempo em frente ao ecrã (η2p = 0,170; p = 0,005) quem mais consome este tipo de alimentos. Conclusões: Observa-se a necessidade de intervir ao nível da promoção e difusão da Dieta Mediterrânica, uma vez que parece ter impacto na diminuição do consumo de alimentos ultraprocessados, de promover a atividade física, estimular hábitos de sono adequados e mitigar o tempo que as crianças e adolescentes passam em frente aos ecrãs.

Conhecimentos e práticas das Amas relativamente à alimentação e nutrição infantil

Mon, 01 Jan 2024 00:00:00 GMT

Title: Conhecimentos e práticas das Amas relativamente à alimentação e nutrição infantil Abstract: A Ama, profissional responsável por assegurar cuidados básicos a crianças, passou a estar enquadrada legalmente, em Portugal, a partir do Decreto-lei n.º158/84. Este elencava requisitos e exigências para todos aqueles cujo objetivo fosse tornar a sua habitação o local de permanência de quatro crianças, entre os três meses e os três anos. Em 2022, ao abrigo da legislação que regulamenta as condições para a concretização da gratuitidade a confeção das refeições passa a ser da responsabilidade das Amas. Com ausência de orientações específicas, sobretudo na seleção e confeção de alimentos, foi objetivo deste trabalho caracterizar atitudes, crenças, valores e práticas relativas à alimentação, perceber o nível de conhecimento e compreender os fatores associados às escolhas alimentares por parte das Amas. Para a recolha de dados, foi utilizada metodologia qualitativa com recurso a entrevista semiestruturada, a partir de uma amostra de conveniência constituída por onze Amas. As entrevistadas, apresentaram atitudes, práticas e experiências diversificadas, fato que poderá estar relacionado com a legislação em vigor à data do seu início de atividade. Identificam como fontes privilegiadas de informação as educadoras de infância e os documentos que recebem nas formações. A aquisição dos géneros ocorre ao fim de semana e consideram os gostos das crianças, a qualidade e o preço como fatores determinantes na seleção. A confeção é feita no início ou final do dia e, na hora, aquecida. Oferecem essencialmente fruta à merenda da manhã, o almoço inclui sopa e prato e a merenda da tarde está dependente dos alimentos enviados pelos pais. Foi percetível que estas profissionais dispõem de parca orientação e legislação, estando a organização e planeamento de refeições dependente dos seus conhecimentos e da capacidade e interesse para a pesquisa de informação.

Intervenção alimentar e nutricional na diverticulose do cólon

Mon, 01 Jan 2024 00:00:00 GMT

Title: Intervenção alimentar e nutricional na diverticulose do cólon Abstract: A diverticulose do cólon consiste na presença de alterações anatómicas em forma de bolsa na parede do intestino grosso, passando a designar-se doença diverticular quando se desenvolvem sintomas. Por sua vez, a doença diverticular, subdivide-se em doença diverticular sintomática não complicada, diverticulite aguda ou crónica (não complicada ou complicada), hemorragia diverticular e colite associada à diverticulose. Têm sido descritos diversos fatores modificáveis que influenciam o desenvolvimento e o tratamento destas condições, em particular a alimentação. Esta revisão temática teve como objetivo descrever e analisar a influência de determinadas opções alimentares e nutricionais na prevenção e no tratamento da diverticulose e da doença diverticular. Foram selecionadas meta-análises, revisões sistemáticas, revisões temáticas, recomendações e trabalhos originais publicados entre 2013 e 2023 disponibilizados nas bases de dados Pubmed e Scopus. Da leitura efetuada, verificámos que a obesidade e a ingestão de álcool são fatores de risco para a diverticulose. Uma maior ingestão de fibra e de vitamina D poderá diminuir o risco de doença diverticular, contrariamente à ingestão de álcool. Não foi encontrada associação com a cafeína. A relação com os oligossacarídeos, dissacarídeos, monossacarídeos e polióis fermentescíveis ainda carece de mais investigação. Em relação aos alimentos, o consumo de frutos oleaginosos, sementes e grãos aparenta diminuir o risco de doença diverticular. Já o consumo de carne vermelha parece ter um papel negativo. No tratamento, a recomendação de ingestão de fibra é diferente de acordo com o subtipo de doença diverticular e a utilização da nutrição artificial pode contribuir para um melhor prognóstico.

NUTRI-YOUNG: impacto dos contextos socioeconómicos nos hábitos alimentares, estilos de vida e satisfação corporal de adolescentes

Mon, 01 Jan 2024 00:00:00 GMT

Title: NUTRI-YOUNG: impacto dos contextos socioeconómicos nos hábitos alimentares, estilos de vida e satisfação corporal de adolescentes Abstract: INTRODUÇÃO: A estruturação de comportamentos promotores de saúde, mas também de risco ocorre frequentemente na adolescência, assim como alterações na composição e imagem corporais. Estas modificações têm um papel determinante na saúde e qualidade de vida futura, pelo que a sua quantificação é essencial. OBJETIVOS: Avaliar comportamentos alimentares e outros estilos de vida de alunos do ensino secundário, a satisfação com a imagem corporal e o estado nutricional; estudar a agregação de estilos de vida menos saudáveis; estabelecer uma análise comparativa entre duas instituições de ensino de meios sociodemográficos distintos. METODOLOGIA: Foi conduzido um estudo transversal, comparativo entre duas instituições de ensino da área metropolitana do Porto (Portugal), uma Escola Profissional e uma Escola de Ensino Particular e Cooperativo. Os alunos, após consentimento do seu representante legal, responderam a questionários estruturados sobre as dimensões em estudo, incluindo um questionário de frequência alimentar validado. Foram efetuadas medições antropométricas por observadores treinados. RESULTADOS: Observou-se uma elevada prevalência de comportamentos de risco em ambas as instituições, particularmente na Escola Profissional, com contexto socioeconómico menos favorecido. No geral, estes parecem ter uma menor adesão a um padrão de estilos de vida mais saudável (média 2,36 vs. 2,73, p=0,021; âmbito variação: 0 a 5). As prevalências de inadequação de macro e micronutrientes foram significativamente superiores na Escola Profissional, embora ambas tenham uma inadequação de ingestão de sódio superior a 75%. A maioria dos alunos encontra-se insatisfeito com a sua imagem corporal (79,2% na Escola Profissional e 61,6% na Escola de Ensino Particular e Cooperativo, p=0,162). A prevalência de sobrecarga ponderal (excesso de peso e obesidade) foi elevada, superior a 30%. CONCLUSÕES: Existem diferenças relevantes nos hábitos alimentares e outros estilos de vida entre alunos de escolas de meios sociodemográficos distintos, que poderão servir de base futura à delineação de intervenções e contribuir para uma melhoria efetiva do ambiente escolar, que se espera promotor de saúde.

Eficácia de intervenções dietéticas e nutricionais na diabetes gestacional – revisão sistemática

Mon, 01 Jan 2024 00:00:00 GMT

Title: Eficácia de intervenções dietéticas e nutricionais na diabetes gestacional – revisão sistemática Abstract: Introdução: A diabetes gestacional é uma das complicações mais comuns da gravidez, associada a altos níveis de inflamação. É caracterizada por alterações do metabolismo glicémico e lipídico num ambiente de inflamação de baixo grau. A terapêutica nutricional tem demonstrado ser coadjuvante ou alternativa ao tratamento farmacológico. Objetivos: Rever sistematicamente e avaliar criticamente as diretrizes mais recentes da terapêutica nutricional para o tratamento da diabetes gestacional. Metodologia: Para a realização desta revisão sistemática, realizou-se uma pesquisa no motor de busca PubMed, utilizando os descritores “gestational diabetes” AND “nutrition”, tendo considerado somente a evidência proveniente de estudos experimentais e publicados desde 2018, até à atualidade. A qualidade dos estudos foi avaliada pela aplicação da ferramenta, Cochrane risk of bias tool (RoB2). Foram incluídos 26 estudos. Resultados: A maioria dos estudos demonstrou que as intervenções dietéticas em grávidas com diabetes gestacional, abrangendo suplementação nutricional, alimentos e padrões alimentares, tiveram efeitos positivos no perfil lipídico, no controlo glicémico, no estado inflamatório, no stress oxidativo, entre outros. Conclusões: A intervenção dietética na diabetes gestacional revelou ter efeitos na redução da necessidade de tratamento farmacológico, na melhoria da glicemia e dos parâmetros relacionados.

Effect of three cooking methods on cooking loss and edible weight of rabbit meat

Mon, 01 Jan 2024 00:00:00 GMT

Title: Effect of three cooking methods on cooking loss and edible weight of rabbit meat Abstract: Introduction: Mediterranean diet features gastronomic heritage that includes rabbit dishes. Some food composition tables present scant information regarding the yield and edible parts of rabbit meat. Objectives: This study seeks to investigate how various cooking techniques impact the cooking loss and edible weight of different cuts of rabbit meat. Methodology: Six male rabbits were slaughtered and the carcasses were dissected: hind leg, ribs, belly, saddle loin, saddle hindquarter and front leg were analysed in duplicated (n=12). Cooking methods included boiling, oven-roasting, and frying until the internal temperature reached 75°C. Post-cooking, samples were cooled, deboned, and weighed to determine edible weight percentage and cooking loss. Results: Frying method was the quickest (from 4.8 to 13.6 minutes), while boiling method was the slowest (from 26.9 to 33.9 minutes). After cooking, the average edible weight was higher in saddle hindquarter (86.7; SD 12.4 g) and saddle loin (52.7; SD 10.1 g) and lower in hind leg (17.8; SD 2.8 g) and belly (13.5; SD 4.6 g). The boiling method presented lower cooking losses (28.2; SD 6.4%) and higher edible weight (51.7; SD 7.6%), and frying the higher cooking loss (36.0; SD 10.0%) and lower edible weight (47.0; SD 8.3%). Conclusions: Boiling demonstrated superior performance despite longer cooking times, while frying showed the least favourable outcomes. This study offers valuable insights for gastrotechnics and culinary management.

Development of a healthy lifestyle assessment index for school-age children

Mon, 01 Jan 2024 00:00:00 GMT

Title: Development of a healthy lifestyle assessment index for school-age children Abstract: Introduction: Assessing children's lifestyles is fundamental for developing policies that prevent the onset of non-communicable diseases. Objectives: To develop a short lifestyle index for school-age children (6 to 9 years old) and assess their lifestyle characterization. Methodology: The index was developed based on data from the 7-year follow-up of the birth cohort Generation XXI (n=4336 children), grouped into four domains: frequency of food consumption, eating behaviours, physical activity (including sedentary behaviours) and sleep duration. Cronbach alpha coefficient was obtained to assess the index internal consistency. Associations between sociodemographic characteristics, the physical environment of the house, and the index score were evaluated through linear regression models, obtaining beta coefficients and respective 95% confidence interval (95%CI). Results: The final index included only two domains (food consumption and physical activity) with a Cronbach alpha of 0.52 and a mean score of 3.6 ± 2.8 (range: -5 to 10). Maternal age (β=1.066; 95%CI=1.045-1.087), years of education (β=1.216; 95%CI=1.186-1.246), having a house with a garden (β=1.630; 95%CI=1.304-2.037), internet access (β=1.524; 95%CI=1.086-2.139) and having a bicycle (β=1.710; 95%CI=1.086-2.694) were positively associated with a healthier lifestyle of the children. Conclusions: The index developed is a short instrument that can be used to evaluate school-age children’s overall lifestyle. Better maternal sociodemographic characteristics and a better house physical environment increase the likelihood of children having a healthier lifestyle.

Assessing response to stressful emotions: a controlled crossover study using pupillometry

Wed, 01 Jan 2025 00:00:00 GMT

Title: Assessing response to stressful emotions: a controlled crossover study using pupillometry Abstract: "Background: Fear and horror induce autonomic protective responses, acting as ""survival intelligence."" Pupillometry is an innovative method that captures real-time autonomic nervous system reactions to stress. Objective: To evaluate the feasibility of pupillometry to assess the acute response to a passive real-life stressor-viewing a truthful war scene. Methods: Thirteen medical students (10 women) with an average age of 20.4 years were enrolled in a nonrandomized controlled crossover trial. Selected clips from two different audiovisual stimuli (M1: Saving Private Ryan as a fear and horror inducer and M2: Life Is Beautiful as a control) were watched for 15 minutes, separated by a washout period of 48-72 hours. The differences in pupillometry parameters between the exposure movie and the assessment time (T0 and T1 for M1 and T0 and T1 for M2) were evaluated using a Wilcoxon test. The Wilcoxon test was also used to assess the difference between M1 and M2 within each assessment time point (T0 and T1). Results: A significant difference in response to acute fear and horror-induced stress was observed in pupillometry parameters {baseline [6.90 (5.95; 7.40) vs. 6.60 (5.55; 7.10), P = 0.030] and final pupil diameter [4.50 (3.90; 5.20) vs. 4.10 (3.50; 4.60), P = 0.012]} between M1 and M2 in T1, suggesting the acute increase in sympathetic parameters. Although not significant, there was also a difference in pupillometry parameters (final pupil diameter [P = 0.060], average constriction velocity [P = 0.059]) after watching M1 compared with T0. Conclusion: Our proof-of-concept study suggests that pupillometry may be used to evaluate changes in the activity of the autonomic nervous system induced by an acute passive stress stimulus."

Diet and special educational needs (SENs) among children and adolescents: a systematic review

Mon, 01 Jan 2024 00:00:00 GMT

Title: Diet and special educational needs (SENs) among children and adolescents: a systematic review Abstract: Special educational needs (SENs) refer to children and adolescents needing additional educational support. Diet during pregnancy and pediatric age can influence the prevalence/severity of symptoms in SEN-related conditions/disabilities. This review aims to summarize associations between (i) pregnant women's diet and the prevalence of SEN-related conditions/disabilities among children/adolescents and (ii) the diet of children/adolescents with SEN-related conditions/disabilities and their symptomatology/well-being. A literature search was performed on Medline and Scopus, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following inclusion criteria were considered, for each aim: (i) children/adolescents aged 19 years and younger, pregnant women's diet/nutrition, and diagnosis of SEN-related conditions/disabilities in children/adolescents; (ii) children/adolescents aged 19 years and younger, children/adolescents' diet/nutrition, and symptomatology/well-being of children/adolescents with SEN-related conditions/disabilities. 87 articles were included, referring to 10 different SEN-related conditions/disabilities, from which attention-deficit/hyperactivity disorder (ADHD) (41 articles) and autism spectrum disorder (ASD) (34 articles) stand out. Noteworthy results were seen regarding maternal caffeine consumption; pregnant woman multivitamin supplementation, high-sugar foods, and beverage intake during childhood/adolescence; maternal breastfeeding; and vitamin D supplementation. Despite the notable associations, further research using more standardized and homogeneous methodologies is needed to strengthen these findings. PROSPERO registration number: CRD42022313235.

Adherence to The Mediterranean Dietary Pattern and Associated Factors Among Adolescents: a Cross-sectional Study from Portugal

Mon, 01 Jan 2024 00:00:00 GMT

Title: Adherence to The Mediterranean Dietary Pattern and Associated Factors Among Adolescents: a Cross-sectional Study from Portugal Abstract: INTRODUCTION: The Mediterranean Dietary Pattern is one of the healthiest dietary models, being associated with several health benefits. However, in recent years, this pattern has been abandoned by adolescents in Mediterranean countries. OBJECTIVES: To determine and analyze the adherence to the Mediterranean Dietary Pattern and its associated factors in a sample of adolescents from a city in the north of Portugal. METHODOLOGY: Cross-sectional study. The data was collected via a stratified one-stage cluster sampling of adolescents (10 to 19 years old) from a city in the north of Portugal. The Mediterranean Diet Quality Index (KIDMED Index) was self-administered to evaluate the adherence to the Mediterranean Dietary Pattern among adolescents. Participants self-reported information about sociodemographic, anthropometric and lifestyle characteristics. Logistic regression was performed to identify the predictors of high adherence to the Mediterranean Dietary Pattern. RESULTS: Most adolescents had a low/moderate adherence to the Mediterranean Dietary Pattern (63.2%). Logistic regression modelling indicated that age and parents educational level were the utmost factors positively related to the possibility of high Mediterranean Dietary Pattern adherence. Sex, school location, body mass index and number of household members did not significantly predict high Mediterranean Dietary Pattern adherence. CONCLUSIONS: These results highlight the importance of the parents education level in adolescents Mediterranean Dietary Pattern adherence, allowing the identification of the priority groups for a possible intervention, namely, younger adolescents and those whose parents have lower educational level.

Caracterização da Oferta Alimentar da Refeição Almoço e Lanche em Creches Portuguesas: Resultados do Projeto "Creche com Sabor e Saúde" C2S

Mon, 01 Jan 2024 00:00:00 GMT

Title: Caracterização da Oferta Alimentar da Refeição Almoço e Lanche em Creches Portuguesas: Resultados do Projeto "Creche com Sabor e Saúde" C2S Abstract: INTRODUÇÃO: Em Portugal não existe um diagnóstico da oferta alimentar das creches. OBJETIVOS: Caracterizar qualitativamente a oferta alimentar das creches nas refeições de almoço e lanche. METODOLOGIA: Estudo transversal com as 18 instituições com valência de Creche do projeto Creche com Sabor e Saúde (C2S), localizadas na região Norte e Centro de Portugal. Cada instituição respondeu a um questionário para caracterizar os procedimentos de gestão das refeições. Para avaliar a refeição almoço, aplicou-se, a 12 semanas de ementas, uma ferramenta de avaliação qualitativa de 23, 47 e 48 itens (a ser aplicada dos 6-8, 9-11 e 12-36 meses, respetivamente). Os lanches foram agrupados por grupo de alimentos e classificados de acordo com uma metodologia de semáforo nutricional desenvolvida neste projeto. Procedeu-se à análise descritiva e aplicou-se o teste t-student para estudar os fatores associados. RESULTADOS: Analisaram-se qualitativamente 54 planos de ementas mensais e a média de conformidades foi de 70,6%. Ao almoço evidenciou-se o excesso de oferta de fruta confecionada (>2x/semana, 61,5%) dos 6-8 meses, a oferta simultânea de sopa e de prato com componente proteica (92,3%) dos 9-11 meses, e a ausência de peixe gordo (<1x/mês, 44,4%) e ovo no prato (<2x/mês, 83,3%) dos 12-36 meses. Nos lanches identificou-se em todas as instituições, a oferta de, pelo menos, um alimento com elevado teor de açúcar e/ou gordura diariamente. CONCLUSÕES: A oferta alimentar nas creches encontra-se desadequada, considerando as orientações das entidades de saúde nacionais/internacionais.

Local Climate Change Adaptation under the Lenses of Public Health: A Case Study from Porto, Portugal

Mon, 01 Jan 2024 00:00:00 GMT

Title: Local Climate Change Adaptation under the Lenses of Public Health: A Case Study from Porto, Portugal Abstract: Introduction: Climate change is a pressing public health issue. Urban populations, especially in coastal areas, are highly vulnerable. As climate change progresses, local adaptation becomes increasingly important. We present a case study about the inclusion of public health concerns in local climate change adaptation in Porto (Portugal). Methods: We analysed two local adaptation plans using qualitative content analysis and conducted semi-structured interviews with a purposeful sample of 6 key stakeholders with different profiles. We did a qualitative content analysis of the respective transcripts. Results: Porto is undergoing health-relevant consequences of climate change, which are expected to worsen further in the future. Porto’s geographical and demographic characteristics and urban environment make its population highly vulnerable to climate change-related health risks. Public health is recognized as a central element in local adaptation efforts. Drivers for integrating health concerns include growing climate change awareness, a sense of urgency, social capital, institutional networks, access to resources, and political commitment. Nevertheless, challenges like data limitations, resource constraints, climate knowledge gaps, communication issues, and political cycles hinder both local adaptation and the integration of health considerations. Discussion/Conclusion: In Porto, health seems both a powerful mobilizing issue and a central topic concerning local adaptation. However, the complex and long-term nature of climate change and the associated uncertainty hinder adaptation efforts. High-quality data about both the local climate and population health are thus essential. The transversal nature of risk is recognized and multi-sectorial approaches, public participation, mainstreaming, and policy integration are necessary to prevent imbalances. Local adaptation efforts, including health-related efforts, are shaped by the international (belonging to the European Union), national, and local contexts. Successful local adaptation and inclusion of health aspects require mainstreaming and policy integration across different areas and involvement of multiple stakeholders, including the population, in order to maximize resources and avoid undesired trade-offs. © 2024 The Author(s)

"AMARRAMOS-TE ALI À CADEIRA" Perceções sobre os ofensores e o risco de violência na idade avançada

Mon, 01 Jan 2024 00:00:00 GMT

Title: "AMARRAMOS-TE ALI À CADEIRA" Perceções sobre os ofensores e o risco de violência na idade avançada Abstract: "This article analyses the experiences and perceptions of a sample of people over 60 about the most frequent type of violence in old age, the risk factors, the offenders and the reactions to abuse. A mixed study was carried out with the sequential application of 677 questionnaires and 45 interviews. The results show that older people are mainly victims of psychological abuse and financial exploitation; the type of abuse varies according to the type of aggressor; and that machismo, ageism, mental health problems, addictive behaviours and social isolation are risk factors for violence. Health and justice professionals are perceived as those to whom victims should turn and confide © 2024 Editora Mundos Sociais. All rights reserved. Este artigo analisa as vivências e perceções de uma amostra de pessoas com mais de 60 anos sobre otipo de violência mais frequente na idade avançada, os fatores de risco, os ofensores e as reações aos abusos. Foirealizado um estudo misto, com a aplicação sequencial de 677 questionários e 45 entrevistas. Os resultadosmostram que as pessoas mais velhas são vítimas principalmente de abuso psicológico e de exploração financeira;o tipo de abuso varia consoante o tipo de agressor/a; e que o machismo, idadismo, problemas de saúde mental,comportamentos aditivos e o isolamento social são fatores de risco de violência. Os profissionais de saúde e dajustiça são percecionados como aqueles a quem as vítimas devem recorrer e confiar."

Long-term Exposure to Ambient Air Pollution and its Association with Mental Well-Being, Depression and Anxiety: A Nationally Representative Study

Mon, 01 Jan 2024 00:00:00 GMT

Title: Long-term Exposure to Ambient Air Pollution and its Association with Mental Well-Being, Depression and Anxiety: A Nationally Representative Study Abstract: "Introduction: Exposure to ambient air pollution may play a role in the onset of common mental disorders like depressive and anxiety disorders. The association of long-term exposure to particles smaller than 10 μm (PM10) with these diseases remains unclear. This study aimed to estimate the association of long-term exposure to PM10 with mental well-being and the frequency of probable diagnosis of common mental disorders. Methods: A nationally representative cross-sectional study was done in mainland Portugal. Long-term exposure was estimated through one-year average concentrations of PM10, calculated with data from the Portuguese Environment Agency, attributed individually considering individuals’ postal codes of residence. The mental well-being and the probable diagnosis of common mental disorders were ascertained through the five-item Mental Health Inventory scale. Linear and Robust Poisson regression models were computed to estimate change percentages, prevalence ratios (PR), and their 95% confidence intervals (95% CI). Results: The median (interquartile range) concentration of PM10 was 18.6 (15.3 - 19.3) μg/m3. The mental well-being score was 72 (56 - 84) points, on a scale from 0 to 100. A probable diagnosis of common mental disorders was found in 22.7% (95% CI: 20.0 to 25.6). Long-term exposure to PM10 was associated with a non-statistically significant decrease in the mental well-being score [for each 10 μg/m³ increment in one-year average PM10 concentrations, there was a 2% (95% CI: -8 to 4) decrease], and with a non-statistically significant increase in the common mental health frequency (PR = 1.012, 95% CI: 0.979 to 1.045). Conclusion: We did not find statistically significant associations between long-term exposure to PM10 and mental well-being or the frequency of probable diagnosis of common mental disorders. These results may be explained by the reduced variability in the exposure values, given the geographical distribution and functioning of the network of air quality monitoring stations. This study contributes with evidence for low levels of air pollutants, being one of the first to adjust for individual and aggregate-level variables. Moreover, to the best of our knowledge, this was the first nationally representative, population-based study conducted on the Portuguese population using real-life data. Maintaining a robust and nationwide air quality monitoring network is essential for obtaining quality exposure data."

Prevalence, characteristics, and impact of spinal and lower limb recurrent pain at age 13

Mon, 01 Jan 2024 00:00:00 GMT

Title: Prevalence, characteristics, and impact of spinal and lower limb recurrent pain at age 13 Abstract: Objectives: To compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. Methods: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. Results: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. Conclusion: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations. © 2024, Sociedade Portuguesa de Reumatologia. All rights reserved.

Dyslipidaemia, and mean blood cholesterol and triglycerides levels in the portuguese population: A systematic review

Sun, 01 Jan 2012 00:00:00 GMT

Title: Dyslipidaemia, and mean blood cholesterol and triglycerides levels in the portuguese population: A systematic review Abstract: Introduction: Dyslipidaemia is a major risk factor for cardiovascular disease, the leading cause of death in Portugal. We aimed to critically summarize the evidence from studies that quantified the distribution of total cholesterol, cholesterol fractions and triglycerides, in order to estimate time trends in the Portuguese adult population. Methods: A systematic review was performed through Pubmed search up to January 2011. References' screening and data extraction were performed independently by two researchers and 28 eligible studies identified. Ecologic estimates of mean total cholesterol, LDL, HDL, and triglycerides were computed by linear regression, adjusting for participants' mean age, year of data collection and geographical coverage. Results: In 2005, the mean total cholesterol at 50 years of age was 215 mg/dL [95% confidence interval (95%CI): 210 to 219] among women and 219 mg/dL (95%CI: 206 to 232) among men. Between 1985 and 2005, the mean adjusted variation in total cholesterol per calendar year was 0.4 mg/dL (95%CI: -0.3 to 1.2) among women and -0.1 mg/dL (95%CI: -0.6 to 0.4) among men. Data on LDL, HDL and triglycerides covered a much narrower period, precluding analysis of time trends. In 2001 the adjusted mean levels of LDL, HDL and triglycerides were 132 mg/dL, 59 mg/dL and 111 mg/dL, respectively, among women, and 132 mg/dL, 49 mg/ dL and 150 mg/dL, respectively, among men. Conclusions: Estimated mean cholesterol, respective fractions, and prevalence of dyslipidaemia suggest a high proportion of high-risk subjects in the Portuguese population. Between 1985 and 2005, mean total cholesterol did not vary significantly.

Social representations of smoking behaviour in 13-year-old adolescents; [Representações sociais do comportamento de fumar em adolescentes de 13 anos]

Sat, 01 Jan 2011 00:00:00 GMT

Title: Social representations of smoking behaviour in 13-year-old adolescents; [Representações sociais do comportamento de fumar em adolescentes de 13 anos] Abstract: Objective: The purpose of this study was to identify adolescents' social representations on smoking using a qualitative approach. Methods: Thirty semi-structured interviews were conducted by trained interviewers. The interviews were recorded with participant's permission after our comprehensive explanation of the interview process. After transcript the content of each interview, information was synthesised under each of main question, and a conceptual content analysis was undertaken. The analysis was performed by two of the authors, and the conflicts were resolved by a third person. Results: Adolescents suggested different explanations for general people and adolescent smoking behaviour. While in general people smoking behaviour was mostly related to dependence, in adolescence it is referred to be associated with status improving among peers and to keep up social relations. We realised that adolescents are aware of the serious health implications of smoking, but they only referred it as a long-term effect in adulthood and no consequences during adolescence were for seen. We also noted the difficulties in giving preventive measures targeted on adolescents. Conclusions: This study points out the importance of peers as agents of socialization in tobacco consumption, and shows the importance of anti-smoking campaigns among this age group with emphasis on smoking consequences in adolescence. © 2010 Published by Elsevier España, S.L. on behalf of Sociedade Portuguesa de Pneumologia.

Pertussis in Portugal - Time for a new strategy; [Pertussis em Portugal - A importância de uma nova estratégia vacinal]

Fri, 01 Jan 2010 00:00:00 GMT

Title: Pertussis in Portugal - Time for a new strategy; [Pertussis em Portugal - A importância de uma nova estratégia vacinal] Abstract: The introduction of routine vaccination against Bordetella pertussis led to a drastic decline in the number of reported cases of pertussis. Nevertheless, a gradual increase in pertussis notifications has been observed in the last years, and political vaccination changes have been conducted in some countries. Pertussis epidemiology is reviewed, taking into account mathematical models studies concerning new vaccinal strategies for pertussis prevention and new international recommendations. Regarding Portugal, the need for a "booster" in adolescence is emphasized, and other recommendations for pertussis control are suggested.