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This study aims to analyze the relationships between various health indicators, using an exploratory graph analysis, repeated measures correlation, and cluster construction. Primary healthcare is essential for providing continuous and comprehensive care, with indicators as crucial tools to identify and improve weaknesses in health units. Data from 41 health units in Baixo Vouga, Portugal, from January 2017 to March 2024, were analyzed. Through the database, the behavior of the indicators and health units over time was identified, along with the strongest positive and negative correlations between the indicators and their graphical illustration. Finally, through clusters, the grouping of indicators and health units was achieved. Thus, this study provides healthcare professionals with important insights for the management and continuous improvement of health units. [ABSTRACT FROM AUTHOR]

Background/Objectives: Acute kidney injury (AKI) is a potential complication of cardiovascular disorders and is associated with worse outcome. The aim of this study was to assess the incidence of early AKI after endovascular therapy for acute ischemic stroke, identify predictors for this complication, and test the association between AKI and mortality or death or dependency. Methods: This was a single-center cohort study involving consecutive patients with acute ischemic stroke submitted to endovascular therapy between 2015 and 2022. AKI was defined according to the KDIGO criteria and evaluated at 48 h. Other outcomes of interest were vital status and functional dependency at 3 months using the modified Rankin Scale, with death or dependency being defined as a score > 2. An adjustment for potential confounders was performed using logistic regression. Results: Overall, 1150 patients were included in the analysis, with a mean age of 74 years and a slight female preponderance (56%). The median NIHSS was 15, the mean onset-to-groin time was 392 min, and 92% of patients were successfully recanalized. The overall incidence rate of AKI was 6%. On univariate analysis, patients with AKI were older (p = 0.002), had a longer time to EVT (p = 0.042), higher NIHSS (p = 0.006), higher blood glucose (p = 0.033), and lower baseline glomerular filtration rate (GFR) (p < 0.001). After adjustment for confounders, AKI was independently associated with NIHSS (p = 0.012), time to treatment (p = 0.004), and lower baseline GFR (p < 0.001). AKI was also independently associated with higher mortality (OR = 2.302, p = 0.003). Conclusions: Patients with impaired baseline renal function and more severe stroke are at higher risk of AKI, and AKI begets worse stroke outcome. Better strategies are required to optimize treatment outcome in these patients and avert this vicious cycle. [ABSTRACT FROM AUTHOR]

Background/Objectives: Population aging is a worldwide phenomenon and is often associated with multimorbidity and polypharmacy. Complex medication regimens are common among older adults and contribute to the occurrence of harmful health outcomes. Age is one of the main risk factors for cancer. This study aimed to determine and characterize the therapeutic complexity in older patients with cancer, and analyze the factors associated with high complexity and the impact of the oncological context. Methods: A cross-sectional study with patients aged ≥65 years with cancer was conducted in three hospitals in northern Portugal. Data collection was obtained using self-reports. The medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI). Descriptive and association statistical analysis were performed. Logistic, linear, simple and multiple regression analysis were conducted, with and without automatic variable selection. Results: A total of 552 patients were included (median age, 71; IQR, 68–76). The mean MRCI before the oncological context was 18.67 (SD 12.60) and 27.39 (SD 16.67) after the oncological context, presenting a statistically significant difference in the values obtained (p < 0.001). An elevated complexity was significantly associated with polypharmacy, chronic diseases and with the administration of high-risk medications (p < 0.05). High MRCI values showed a relationship with the occurrence of potential drug interactions (p < 0.001). There was no relationship with the existence of cardiac risk comorbidity. Conclusions: This study demonstrated the existence of high therapeutic complexity in older patients with cancer, suggesting the need for intervention to prevent medication-related problems in this vulnerable population. [ABSTRACT FROM AUTHOR]

This review explores the diverse landscape of integrating nutrition and physical activity education into medical school curricula, focusing on the imperative role of physicians in promoting health through lifestyle changes. By examining global medical education structures, we uncovered disparities in nutrition and physical activity training, and highlighted the need for a shared framework to address international and regional challenges. Despite acknowledging the importance of both nutrition and physical activity, studies have consistently uncovered deficiencies in medical school curricula, especially in skills related to providing lifestyle advice and behavioral counseling. Survey studies among medical students have illuminated various perceptions and knowledge gaps, emphasizing the need for more comprehensive and mandatory nutrition and physical activity training. While acknowledging progress, challenges, such as time constraints, resource availability, and faculty expertise, persist. Integrating lifestyle education results in resistance, a demand for strategic communication, and faculty buy-ins. These findings underscore the importance of a holistic approach that balances theoretical knowledge, practical skills, and confidence that medical students need to promote effective nutrition and physical activity in healthcare. [ABSTRACT FROM AUTHOR]

Selecting features associated with patient-centered outcomes is of major relevance yet the importance given depends on the method. We aimed to compare stepwise selection, least absolute shrinkage and selection operator, random forest, Boruta, extreme gradient boosting and generalized maximum entropy estimation and suggest an aggregated evaluation. We also aimed to describe outcomes in people with chronic obstructive pulmonary disease (COPD). Data from 42 patients were collected at baseline and at 5 months. Acute exacerbations were the aggregated most important feature in predicting the difference in the handgrip muscle strength (dHMS) and the COVID-19 lockdown group had an increased dHMS of 3.08 kg (CI95 ≈ [0.04, 6.11]). Pack-years achieved the highest importance in predicting the difference in the one-minute sit-to-stand test and no clinical change during lockdown was detected. Charlson comorbidity index was the most important feature in predicting the difference in the COPD assessment test (dCAT) and participants with severe values are expected to have a decreased dCAT of 6.51 points (CI95 ≈ [2.52, 10.50]). Feature selection methods yield inconsistent results, particularly extreme gradient boosting and random forest with the remaining. Models with features ordered by median importance had a meaningful clinical interpretation. Lockdown seem to have had a negative impact in the upper-limb muscle strength. [ABSTRACT FROM AUTHOR]

In this work, we aimed to establish a stable and accurate procedure with which to perform feature selection in datasets with a much higher number of predictors than individuals, as in genome-wide association studies. Due to the instability of feature selection where many potential predictors are measured, a variable selection procedure is proposed that combines several replications of shrinkage regression models. A weighted formulation is used to define the final predictors. The procedure is applied for the investigation of single nucleotide polymorphism (SNP) predictors associated with Alzheimer's disease in the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. Furthermore, the two following data scenarios are investigated: one that solely considers the set of SNPs, and another with the covariates of age, sex, educational level, and ε4 allele of the Apolipoprotein E (APOE4) genotype. The SNP rs2075650 and the APOE4 genotype are provided as risk factors for Alzheimer's disease, which is in line with the literature, and another four new SNPs are indicated, thus cultivating new hypotheses for in vivo analyses. These experiments demonstrate the potential of the new method for stable feature selection. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic remains a global problem that affects the health of millions of people and the world economy. Identifying how the movement of people between regions of the world, countries, and municipalities and how the close contact between individuals of different age groups promotes the spread of infectious diseases is a pressing concern for society, during epidemic outbreaks and pandemics, such as COVID-19. Networks and Graph Theory provide adequate and powerful tools to study the spread of communicable diseases. In this work, we use Graph Theory to analyze COVID-19 transmission dynamics between municipalities of Aveiro district, in Portugal, and between different age groups, considering data from 2020 and 2021, in order to better understand the spread of this disease, as well as preparing actions for possible future pandemics. We used a digraph structure that models the transmission of SARS-CoV-2 virus between Aveiro's municipalities and between age groups. To understand how a node fits over the contact digraphs, we studied centrality measures, namely eigencentrality, closeness, degree, and betweenness. Transmission ratios were also considered to determine whether there were certain age groups or municipals that were more responsible for the virus's spread. According to the results of this research, transmissions mostly occur within the same social groupings, that is, within the same municipalities and age groups. However, the study of centrality measures, eliminating loops, reveals that municipalities such as Aveiro, Estarreja and Ovar are relevant nodes in the transmission network of municipalities as well as the age group of 40–49 in the transmission network of age groups. Furthermore, we conclude that vaccination is effective in reducing the virus. [ABSTRACT FROM AUTHOR]

Functional status is an important and meaningful outcome in people with chronic obstructive pulmonary disease (COPD), although its measurement is not embedded in routine clinical assessments. This study described the functional status of people with COPD using the 1-min sit-to-stand test (1minSTS) over a 6-month period and the examined sociodemographic and clinical characteristics associated with this outcome. Data from a prospective study including people with COPD were analyzed. Functional status was assessed monthly with the 1minSTS over 6 months. Linear-mixed effect models assessed the 1minSTS number of repetitions mean change. One-hundred and eight participants (82.4% men; 66.9 ± 9.5 years) were included. A significantly lower number of repetitions in the 1minSTS over the 6-month period was associated with being female (estimate: −4.69, 95%CI: −8.20; −1.18), being older (estimate: −0.56, 95%CI: −0.77; −0.34), having higher BMI (estimate: −0.55, 95%CI: −0.81; −0.28) and having higher activity-related dyspnea (estimate: −2.04, 95%CI: −3.25; −0.83). Half of the participants showed improvements above three repetitions in the 1minSTS over the 6-month period, independently of their baseline impairment (1minSTS < 70% predicted: 52.5%; ≥70% predicted: 54.4%). To conclude, monthly follow-up assessments were associated with clinically relevant benefits in the functional status of people with COPD. Age, body composition, and activity-related dyspnea were the main predictors of functional status over time. Further research is needed to corroborate our findings and to support the beneficial effects of regular COPD monitoring. [ABSTRACT FROM AUTHOR]

Adverse drug reactions (ADR) significantly impact mortality and morbidity and lead to high healthcare costs. Reporting ADR to regulatory authorities allows for monitoring the safety and efficacy profile of medicines on the market and for assessing the benefit–risk ratio. This retrospective study aims to characterize the ADR profile of the most consumed antibiotics in Portugal that are prescribed for upper airway infections and submitted to the EudraVigilance database. The variables were analyzed in an exploratory perspective, through absolute and relative frequencies, with emphasis on serious ADR. A total of 59,022 reports were analyzed of which 64.4% were classified as suspected serious ADR. According to serious ADR, the female sex (52.2%) and 18–64 age group (47.5%) prevail. Health professionals reported 87.8% of suspected serious ADR and European Economic Area (EEA) countries represented 50.8% of the reports. "Skin and subcutaneous tissue connections" (15.9%), "general disorders and administrations site conditions" (12%), and "gastrointestinal disorders" (9.8%) are the prevalent system organ classes. In 4.5% of the reports, patients had a fatal outcome. A periodic evaluation of the safety of the antibiotic should be performed to facilitate the development of guidelines and policies to reduce the frequency of serious ADR. [ABSTRACT FROM AUTHOR]

Background: we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of exercise training on cardiac function and circulating biomarkers outcomes among women with breast cancer (BC) receiving anthracycline or trastuzumab-containing therapy. Methods: PubMed, EMBASE, Cochrane Library, Web of Science and Scopus were searched. The primary outcome was change on left ventricular ejection fraction (LVEF). Secondary outcomes included diastolic function, strain imaging and circulating biomarkers. Results: Four RCTs were included, of those three were conducted during anthracycline and one during trastuzumab, involving 161 patients. All trials provided absolute change in LVEF (%) after a short to medium-term of treatment exposure (≤6 months). Pooled data revealed no differences in LVEF in the exercise group versus control [mean difference (MD): 2.07%; 95% CI: −0.17 to 4.34]. Similar results were observed by pooling data from the three RCTs conducted during anthracycline. Data from trials that implemented interventions with ≥36 exercise sessions (n = 3) showed a significant effect in preventing LVEF decline favoring the exercise (MD: 3.25%; 95% CI: 1.20 to 5.31). No significant changes were observed on secondary outcomes. Conclusions: exercise appears to have a beneficial effect in mitigating LVEF decline and this effect was significant for interventions with ≥36 exercise sessions. [ABSTRACT FROM AUTHOR]