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This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age ( p  < .001) and inversely related to schooling ( p  < .001) and predominated in non-white women ( p  < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation.Impact Statement What is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births. What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years. What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.

The aim of this study was to provide a synthesis of published studies investigating education-based arbovirus control strategies. The data were collected from the LILACS, BDENF and MEDLINE databases using the descriptors "Health Education" and "Aedes", together with the Boolean operator "AND". The searches retrieved 242 studies, 14 of which were included in the review after applying the inclusion and exclusion criteria. The data were analyzed using a qualitative approach, resulting in the identification of four categories: vector control actions based on community capacity building; social mobilization for arbovirus control; education-based vector control combined with biological control; and integrated arbovirus control actions. The findings show that health education is an essential element of arbovirus control and should be implemented in conjunction with other vector control strategies.

Although it is a versatile tendon, only 1% of surgeons choose to use the quadricipital tendon as a graft in anterior cruciate ligament (ACL) reconstruction. The present article aims to describe a quadricipital graft removal technique in which its deepest part is maintained. The technique consists of an approach in which the first incision is made in the medial part of the quadricipital tendon to prevent it from getting too short. This is due to its triangular design. The technique also addresses the depth and identification of the three layers of the quadricipital tendon so that it is possible to preserve its deepest part. This approach aims to preserve the extensor apparatus and to not communicate it with the joint environment, avoiding fluid extravasation both in the trans and postoperative periods., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To analyse the factors related to suffering in chronic patients within the hospital context., Method: Descriptive-correlational and cross-sectional quantitative study. Conducted in a hospital in central Portugal, between January and June 2013. A convenience sample of 307 chronic patients was selected. The variables collected through the questionnaire were: age, sex, marital status, employment status, monthly income, perception of family functioning (Smilkinstein), clinical pathology, spirituality (Pinto and Pais-Ribeiro) and degree of suffering (McIntyre and Gameiro). The project was approved by the hospital's ethics committee. The participants signed an informed consent form., Results: The global suffering of chronic patients studied at the hospital level is moderate (M=3.01), on a scale of 1 to 5, with the psychological dimension being the most affected (M=3.18). Elderly patients suffer more physically and have more positive experiences. Women present greater socio-relational and psychological suffering. On the other hand, people who live alone, with a monthly income of less than 300 euros, with a low level of education, with the perception of belonging to a dysfunctional family and with neurological pathology, suffer the most. Multiple linear regression showed that spirituality is significantly inversely correlated with suffering. Beliefs are responsible for 6.0% of the explained variance of suffering and hope / optimism for 3.3%., Conclusions: People with chronic hospitalized diseases experience multidimensional suffering, with variable intensity and that is correlated with several factors. These variables must be considered for correct planning of health care for this population adapted to their specific needs., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

The potential of exosomes as biomarker resources for diagnostics and even for therapeutics has intensified research in the field, including in the context of Alzheimer´s disease (AD). The search for disease biomarkers in peripheral biofluids is advancing mainly due to the easy access it offers. In the study presented here, emphasis was given to the bioinformatic identification of putative exosomal candidates for AD. The exosomal proteomes of cerebrospinal fluid (CSF), serum and plasma, were obtained from three databases (ExoCarta, EVpedia and Vesiclepedia), and complemented with additional exosomal proteins already associated with AD but not found in the databases. The final biofluids' proteomes were submitted to gene ontology (GO) enrichment analysis and the exosomal Aβ-binding proteins that can constitute putative candidates were identified. Among these candidates, gelsolin, a protein known to be involved in inhibiting Abeta fibril formation, was identified, and it was tested in human samples. The levels of this Aβ-binding protein, with anti-amyloidogenic properties, were assessed in serum-derived exosomes isolated from controls and individuals with dementia, including AD cases, and revealed altered expression patterns. Identification of potential peripheral biomarker candidates for AD may be useful, not only for early disease diagnosis but also in drug trials and to monitor disease progression, allowing for a timely therapeutic intervention, which will positively impact the patient's quality of life.

The loss of proteostasis during aging has been well described using different models, however little is known with respect to protein aggregation levels in biofluids with aging. Therefore, the aim of this study was to assess the pattern of age-related protein aggregation in human plasma using two distinct approaches: analysis with conformation-specific antibodies and FTIR spectroscopy. The latter has been widely used in biomedical research to study protein conformational changes in health and disease. Samples from a primary care based-cohort from the Aveiro region, Portugal, were used for slot-blot analyses followed by immunodetection with conformation-specific antibodies and for the acquisition of FTIR spectra. Immunoblot analyses revealed an age-dependent evolution of the protein conformational profile in human plasma, towards a decrease in prefibrillar oligomers and an increase in fibrillar structures. This finding was also supported by PLS-R multivariate analysis of FTIR data, where a positive correlation between the age of the donors and secondary structure of plasma proteins could be observed. Samples from younger donors are characterized by antiparallel β-sheet-containing structures while intermolecular β-sheets characterized older samples. Exclusion of age-associated co-morbidities improved the correlation between protein conformational profiles and aging. The results reveal structural changes in human plasma proteins from middle to old age, confirming the age-associated changes in protein aggregation, and support the applicability of FTIR as a reliable approach to study proteostasis during aging., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Birth weight is a major contributor to neonatal morbidity and mortality and is associated with chronic diseases in adulthood. This study aimed to evaluate the use of Intergrowth 21st instead of the Fenton & Kim 2013 growth charts in the diagnosis of small and large for gestational age in a group of Portuguese newborns., Material and Methods: We conducted an analytical and retrospective study to evaluate birth weight of term and preterm newborns using both growth charts. Groups studied: 'Term-weeks' and 'Term-days' (term newborns with gestational age in weeks and days, respectively), 'Preterm-weeks' and 'Preterm-days' (preterm newborns with gestational age in weeks and days, respectively)., Results: A total of 14 056 newborns were included, 6% preterm. Using the Intergrowth 21st growth charts, the groups 'Term-weeks' (n = 12 081), 'Term-days' (n = 1118), 'Preterm-weeks' (n = 617) and 'Preterm-days' (n = 240), classified as small for gestational age according to the Fenton & Kim 2013 growth charts were adequate for gestational age in 52.8%, 57.8%, 37.7% and 9.3% respectively; and 9.2%, 9.2%, 5.9% and 0.6% of adequate for gestational age newborns were large for gestational age, respectively. In the 'Pretermdays' group, 7.9% of adequate for gestational age newborns were small for gestational age and 22.2% of large for gestational age newborns were adequate for gestational age, all with gestational age below 231 days., Discussion: The use of the Intergrowth 21st growth charts in this sample resulted in a lower number of newborns being classified as small for gestational age, except in very preterm newborns., Conclusion: Considering the results obtained, we suggest that Portuguese maternity hospitals use the Intergrowth 21st instead of the Fenton & Kim 2013 growth charts. However, more studies are needed to confirm these results.

Objective: Sleep disturbances are frequent in infants. Early development of sleep routines has a positive effect on sleep quality. The objective of this study was to assess the impact of maternal education on the development of infants' sleep habits (SHs)., Methods: This was an experimental, longitudinal study. Postnatal mothers were allocated into two groups: to receive (intervention group, IG), or not receive (control group, CG) information on sleep hygiene. Individual 15-min sessions were provided and a leaflet was handed to the IG. A questionnaire on infants' SHs was applied by telephone/e-mail at 1, 2, 4, and 6 months of age., Results: At least three questionnaires were answered by 314 mothers. Results were adjusted for maternal age, education, and race. In the IG, infants acquired more independent sleep habits, an effect still present at six months; slept more frequently in their own beds; adjusted odds ratio (OR adj ) 3.8, 95% confidence interval (CI) (1.1-13.5); fell asleep more frequently alone (OR adj , 4.29; 95% CI, 2.4-7.6); fell asleep more frequently in their own beds (OR adj , 6.1; 95% CI, 3.5-10.6) and needed less breast/bottle feeding to fall asleep (OR adj , 2.68; 95% CI, 1.5-4.6). The autonomy was greater in IG infants after night awakenings; also until six months they went back to sleep more frequently alone (OR adj , 3.88; 95% CI, 2-7.5) and needed less breast/bottle feeding (OR adj , 2.35; 95% CI, 1.3-4.3). No differences were found regarding the need for light, television or other routines to fall asleep or after night awakenings., Conclusion: Maternal education is positively associated with the adoption of autonomous SHs in infants. Early maternal education is an adequate prevention strategy to be considered in neonatal care., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The potential of exosomes as biomarker resources for diagnostics, prognostics and even for therapeutics is an area of intense research. Despite the various approaches available, there is no consensus with respect to the best methodology for isolating exosomes and to provide substantial yields with reliable quality. Differential centrifugation is the most commonly used method but it is time-consuming and requires large sample volumes, thus alternative methods are urgently needed. In this study two precipitation-based methods and one column-based approach were compared for exosome isolation from distinct biofluids (serum, plasma and cerebrospinal fluid). Exosome characterization included morphological analyses, determination of particle concentration, stability and exosome preparations' purity, using different complementary approaches such as Nanoparticle Tracking Analysis, Electrophoretic Light Scattering, Transmission Electron Microscopy, EXOCET colorimetric assay, protein quantification methods and western blotting. The three commercial kits tested successfully isolated exosomes from the biofluids under study, although ExoS showed the best performance in terms of exosome yield and purity. Data shows that methods other than differential centrifugation can be applied to quickly and efficiently isolate exosomes from reduced biofluid volumes. The possibility to use small volumes is fundamental in the context of translational and clinical research, thus the results here presented contribute significantly in this respect., Competing Interests: The commercial affiliation Paralab SA, does not alter author’s adherence to all PLOS ONE policies, on sharing data and materials.

The objective of this study was to integrate findings related to Zika virus from the scientific literature. An integrative review of Medline was conducted, and data search was performed using the Health Sciences Descriptor Zika virus and the following filters: full texts available; studies in humans; full articles; and publications in Portuguese, French, English, and Spanish. After application of the filters, followed by reading of the titles, abstracts, and full texts, 44 studies were included in the review, for which content analysis was performed. A large part of the literature comprised review articles (84%; N=37); the majority was in English (95%, N=42). In 2016, 84% (N=37) of our sample articles was published, while in 2017, 16% (N=7) was published. The main form of viral transmission was thorough the mosquito Aedes aegypti (N=30). In addition, sexual transmission (N=09), transmission through blood transfusion (N=16), vertical transmission (N=21) and transmission from occupational activities (N=03) occurred. It was possible to diagnose the disease by testing blood (N=22), urine (N=14), saliva (N=06), semen/sperm (N=03), cerebrospinal and amniotic fluid, and other tissues (N=02). Symptomatology occurred in 1-5 people (N=10) between 3 and 7 days after a mosquito bite (N=09). Complications observed were Guillain Barré syndrome (N=27); neurological Zika syndrome (N=27); meningitis, meningoencephalitis, and myelitis (N=07); deaths and/or newborns (N=03). The review provides scientific evidence that contributes to the care, planning and implementation of public policies.

Purpose: To investigate the relation between optical properties, population receptive fields (pRFs), visual function, and subjectively perceived quality of vision after cataract surgery., Methods: The study includes 30 patients who had recently undergone bilateral sequential cataract surgery. We used functional magnetic resonance imaging and pRF modelling methods to assess pRF sizes across visual cortical regions (V1-V3). Subjects also performed a complete ophthalmologic and psychophysical examination and answered a quality of vision questionnaire., Results: Subjects with worse optical properties had, as predicted, larger pRF sizes. In addition, analysis in the primary visual cortex revealed significantly larger mean pRF sizes for operated subjects with worse contrast sensitivity (P = 0.038). In contrast, patients who scored high in the subjective "bothersome" dimension induced by dysphotic symptoms had surprisingly lower pRF size fitting interception (P = 0.012) and pRF size fitting slopes (P = 0.020), suggesting a dissociation between objective quality of vision and subjective appraisal., Conclusions: Optical properties of the eye influence pRF size. In particular, visual aberrations have a negative impact on visual cortical processing. A novel dissociation between subjective reports of quality of vision and pRF sizes was further identified. This suggests that patients with better cortical resolution may have a negative subjective response possibly because of improved perception of dysphotic phenomena. pRF properties represent a valuable quantitative measure to objectively evaluate quality of vision but do not necessarily predict subjective complaints.

Succinic acid is a platform chemical that plays an important role as precursor for the synthesis of many valuable bio-based chemicals. Its microbial production from renewable resources has seen great developments, specially exploring the use of yeasts to overcome the limitations of using bacteria. The objective of the present work was to screen for succinate-producing isolates, using a yeast collection with different origins and characteristics. Four strains were chosen, two as promising succinic acid producers, in comparison with two low producers. Genome of these isolates was analysed, and differences were found mainly in genes SDH1, SDH3, MDH1 and the transcription factor HAP4, regarding the number of single nucleotide polymorphisms and the gene copy-number profile. Real-time PCR was used to study gene expression of 10 selected genes involved in the metabolic pathway of succinic acid production. Results show that for the non-producing strain, higher expression of genes SDH1, SDH2, ADH1, ADH3, IDH1 and HAP4 was detected, together with lower expression of ADR1 transcription factor, in comparison with the best producer strain. This is the first study showing the capacity of natural yeast isolates to produce high amounts of succinic acid, together with the understanding of the key factors associated, giving clues for strain improvement., (© FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

During must fermentation by Saccharomyces cerevisiae strains thousands of volatile aroma compounds are formed. The objective of the present work was to adapt computational approaches to analyze pheno-metabolomic diversity of a S. cerevisiae strain collection with different origins. Phenotypic and genetic characterization together with individual must fermentations were performed, and metabolites relevant to aromatic profiles were determined. Experimental results were projected onto a common coordinates system, revealing 17 statistical-relevant multi-dimensional modules, combining sets of most-correlated features of noteworthy biological importance. The present method allowed, as a breakthrough, to combine genetic, phenotypic and metabolomic data, which has not been possible so far due to difficulties in comparing different types of data. Therefore, the proposed computational approach revealed as successful to shed light into the holistic characterization of S. cerevisiae pheno-metabolome in must fermentative conditions. This will allow the identification of combined relevant features with application in selection of good winemaking strains., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To describe the process of validating Emotional Intelligence Measurement (MIE) Scale for Portuguese senior citizens., Design: Observational, cross-sectional quantitative study., Framework: Senior citizens attending senior universities and from the community in the district of Viseu., Participants: 1084 subjects participated with a mean age of 72.98 years, residing in the district of Viseu, no longer involved in formal activities (retired) and participating voluntarily in study., Main Measurements: the Emotional Intelligence Measuring (MIE) Scale, socio-demographic characteristics (age, gender, marital status, residence). An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of the MIE scale were performed., Results: The MIE showed very good internal consistency (Cronbach's alpha=0.952). The main component and rotation factor analysis varimax extracted 36 items and five factors which explain 54.78% of the total variance. After confirmatory factor analysis and re-specification of the model, the global indicator values of the adjustment model for the MIE revealed a quality of good fit (X(2)/df=3.46; RMR=0.025). The final version of the MIE was composed of 33 items and five factors that represent emotional intelligence skills: Factor 1 - Empathy (12 items); Factor 2 - Self-motivation (10 items); Factor 3 - Self-awareness (4 items); Factor 4 - Self-control (4 items); Factor 5 - Sociability (3 items)., Conclusion: The MIE scale is shown to be suitable to assess emotional intelligence in Portuguese senior citizens., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Introduction: The aging population is increasing worldwide, but the abuse and mistreatment in the elderly (often silenced forms) has also been increasing, with strong implications for their quality of life., Objective: To identify forms of abuse and ill-treatment in the elderly, as well as the determinants of these abuses., Methodology: This is a quantitative study, of the non-experimental, descriptive, cross-sectional type attended by 135 Portuguese elderly. It uses the Family APGAR Scale and the Question to Elicit Elder Abuse (QEEA), which was applied between January and June 2013, in the elderly residing in the central of Portugal., Results: The data shows that 23.5% of the elderly have suffered some kind of abuse, these being especially of the emotional kind and neglect. We also found that the most abused elders were unmarried and widows, those who had lower academic qualifications, those who reported feeling lonely and less healthy and even those who perceive to integrate families with some degree of dysfunction., Conclusion: We found that the abuse and mistreatment are present in the everyday life of many seniors and are a difficult subject to approach. The evidence, invite us to reflect on the development of intervention strategies, particularly at the levels of emotional abuse, neglect, promotion of health and family functioning in order to contribute to the reduction or extinction of abuse and ill-treatment in the elderly., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Objective: To characterize sources of information students of higher education turn to for clarification about AIDS., Research Design: Cross-sectional, non-experimental research, with the features of descriptive, correlational and explanatory studies. The data collection protocol includes personal and academic data and the sources of information about AIDS scale., Participants: 2002 students participated, 60.7% girls (X=21.76; years ± 4.43 SD), of the first and last years of higher education in the North and Centre of Portugal., Results: Students rely mainly on reading informational materials for information about AIDS. Approximately 37% have good information on AIDS with young people up to the age of 25 and attending courses in field of health having higher scores., Conclusions: Changes are needed in health education models in the area of HIV/AIDS, since these are not showing a satisfactory level of efficiency. On the other hand, it is important to motivate young people to change their behaviours. Although many young people have knowledge, they do not change their risk behaviours., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

This work describes the utility and efficiency of a metabolic profiling pipeline that relies on an unsupervised and untargeted approach applied to a HS-SPME/GC-MS data. This noninvasive and high throughput methodology enables "real time" monitoring of the metabolic changes inherent to the biochemical dynamics of a perturbed complex biological system and the extraction of molecular candidates that are latter validated on its biochemical context. To evaluate the efficiency of the pipeline five different fermentations, carried on a synthetic media and whose perturbation was the nitrogen source, were performed in 5 and 500 mL. The smaller volume fermentations were monitored online by HS-SPME/GC-MS, allowing to obtain metabolic profiles and molecular candidates time expression. Nontarget analysis was applied using MS data in two ways: (i) one dimension (1D), where the total ion chromatogram per sample was used, (ii) two dimensions (2D), where the integrity time vs m/z per sample was used. Results indicate that the 2D procedure captured the relevant information more efficiently than the 1D. It was also seen that although there were differences in the fermentation performance in different scales, the metabolic pathways responsible for production of metabolites that impact the quality of the volatile fraction was unaffected, so the proposed pipeline is suitable for the study of different fermentation systems that can undergo subsequent sensory validation on a larger scale.

Neuroplasticity refers to the ability of the brain to reorganize the function and structure of its connections in response to changes in the environment. Adult human visual cortex shows several manifestations of plasticity, such as perceptual learning and adaptation, working under the top-down influence of attention. Plasticity results from the interplay of several mechanisms, including the GABAergic system, epigenetic factors, mitochondrial activity, and structural remodeling of synaptic connectivity. There is also a downside of plasticity, that is, maladaptive plasticity, in which there are behavioral losses resulting from plasticity changes in the human brain. Understanding plasticity mechanisms could have major implications in the diagnosis and treatment of ocular diseases, such as retinal disorders, cataract and refractive surgery, amblyopia, and in the evaluation of surgical materials and techniques. Furthermore, eliciting plasticity could open new perspectives in the development of strategies that trigger plasticity for better medical and surgical outcomes.

Introduction: Although aging is not synonymous with illness and dependency, the process enhances the progressive limitation of the capabilities of the individual to meet daily living activities with autonomy, leading to greater need for informal and / or formal support., Objectives: To identify the functional independence of the participants and their relation to the socio demographic, clinical, housing and social support variables;to assess the difficulties of informal caregivers in care when returning home., Method: We opted for a triangulated methodology (quantitative and qualitative) following a descriptive-correlational path, using for this purpose a non-probabilistic sample of convenience consisting of 50 patients admitted in the Centro Hospitalar Tondela - Viseu, EPE, and their informal caregivers. The measuring instruments used were the Barthel Index and a semi-structured interview., Results: The participants are mostly male, with an average age of 73.7 years, married, residing in rural areas. Their qualifications are the 1st cycle of basic education (four years of Primary School) and have a predominance of cerebrovascular diseases. They show moderate dependence at discharge, preferably returning to their own home. Functional independence is significantly influenced by age, educational attainment, place of residence after admission, housing adaptation and formal support. The informal caregiveris mainly the female spouse and daughters, presenting as main difficulties, employment, lack of support andtechnical assistance, the existence of architectural barriers and caregiver overload., Conclusions: The inexistent of the caregiver's profile, their absence or inability to care was predictive of institutionalization.

Joinville is an important industrial city in Santa Catarina, southern Brazil, and also a risk factor for the Babitonga drainage basin. Oxidative stress-related parameters were evaluated in caged tilapia (Oreochromis niloticus) exposed for 7 days (sites S1 and S2) in a Babitonga drainage basin tributary river. Site S1 showed enhanced levels of hepatic CYP1A, CYP2B-like and glutathione S-transferase activity, while site S2 showed decreased levels of glutathione and increased lipoperoxidation indexes, catalase, glutathione peroxidase and glutathione reductase activity. Correlation analyses revealed that oxidative stress-related parameters behaved like a group of interrelated variables, while CYPs and glutathione S-transferase seem to be independent. New putative biomarkers were evaluated in the tilapia brain. Caspase-3 activation (both sites), decreased in p38MAPK phosphorylation (site S2) and decreased expression in HSP70 (site S1) were observed. Data indicate that employed variables, when used as a group (oxidative stress-related parameters, CYP1A/2B-like, caspase-3, HSP70 and protein kinases) can be useful as predictors of pollution., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Multiple Sclerosis (MS) is the most common demyelinating disease of the Central Nervous System. It is more frequently diagnosed in young individuals between 20 and 40 years old. MS is the leading non-traumatic cause for disability in young adults in western countries. Portuguese prevalence of the disease is about 50 per 100,000 inhabitants, which means that there are around 5,000 people with MS in Portugal. Our goal was to determine social and economic implications of MS through the description of patient's quality of life and economic difficulties, and to assess the dividend spent by the National Health System (NHS) with this disease. The studied population consisted of 50 individuals with MS in any stage of the disease to whom no exclusion criteria were used. The following questionnaires were applied: Multiple Sclerosis: Socio-Economic Implications and MS and Quality of Life (MSQoL-54). For data processing purposes we used SPSS v.16 and Microsoft Excel 2003. The confidence interval was 95%. In addition we based the cost calculations on K and C constants (official values from 2002). The results obtained were similar to those described in literature in what concerns the clinical presentation and the onset of the disease. Social implications evaluated by MSQoL revealed the majority of the inquiries had a score above 50 (n = 31). In what concerns economic implications the value of 40 843 250 euro was obtained as the mínimum spent by NHS. This number probably represents an under-valorization of the real value since only the direct costs were analyzed. It is necessary that new studies especially with bigger study populations can determine precisely the economic impact of MS in the Portuguese society.

Most patients on chronic oral anticoagulant therapy are monitored through anticoagulation clinics, or rather by assistant physicians. Our aim was to compare warfarin anticoagulated patients who were treated with usual medical care (assistant physician) with those treated routinely at an anticoagulation clinic for anticoagulation control. The later was assessed by comparing in both groups of patients the proportion of INRs within the therapeutic range, above 5.0 and below 1.5. The group treated at an anticoagulation clinic achieved better anticoagulation control (both among the patients receiving lower-range anticoagulation therapy and in the patients requiring higher-range anticoagulation therapy) than the group treated with usual medical care.

Background: Although previous reports have described the association of autism, mental retardation, and schizophrenia with a missing Y chromosome, we are not aware of any case showing an association between this particular chromosomal abnormality and Asperger syndrome., Method: We report the case of a male patient with a combination of Asperger syndrome, obsessive-compulsive disorder and 45,X/46,XY mosaicism. During the follow-up, this individual has also developed a severe episode of major depression, which was successfully treated with electroconvulsive therapy., Results: To the best of our knowledge, this is the first case in which a 45,X/46,XY mosaicism was described in association with Asperger syndrome, either alone or associated with other psychiatric disorders. Diagnostic and therapeutic aspects of this unique case are presented and discussed., Conclusions: Our findings suggest that a missing Y chromosome may play an etiological role in some cases of Asperger syndrome., (Copyright 2004 S. Karger AG, Basel)