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BACKGROUND Hypothermia in trauma patients causes increased morbidity and mortality. Swift recognition and treatment are important to prevent any further heat loss. In addition, patient discomfort from cold decreases satisfaction with care. The administration of active and passive rewarming measures is important in the prevention and treatment of hypothermia, but their use in prehospital trauma patients in Portugal has not been previously reported. OBJECTIVE To assess the prevalence of hypothermia, the impact of rewarming measures, and the management of the discomfort caused by cold. METHODS This is a prospective cohort study conducted in Immediate Life Support Ambulances in Portugal between March 1, 2019, and April 30, 2020. RESULTS This study included records of 586 trauma patients; of whom, 66.2% were men. Cranioencephalic trauma was the most common trauma observed, followed by lower limb and thoracic traumas. Mean body temperature increased 0.12 °C between the first and last assessments (p < .05). Most patients experiencing a level of discomfort of 5 or more on a 0-10 scale reported improvement (from 17.2% to 2.4% after nurses' intervention). Warmed intravenous fluids proved to be effective (p < .05) in increasing body temperature, and passive rewarming measures were effective in preventing hypothermia. CONCLUSIONS Hypothermia management has to consider the initial temperature, the season, the available rewarming measures, and the objectives to be achieved. The optimization of resources for the monitoring and treatment of hypothermia should be a priority in prehospital assistance. The implementation of rewarming measures improves patients' outcomes and decreases the discomfort caused by cold in prehospital care.

ObjectivesThere is an unmet need for accurate and user-friendly definitions of systemic lupus erythematosus (SLE) disease activity and remission. We aimed to derive and validate the SLE Disease Activity Score (SLE-DAS) definitions for disease activity categories and clinical remission state.MethodsDerivation was conducted at Padova Lupus Clinic (Italy). Validation was prospectively performed at Cochin Lupus Clinic (France) and by post hoc analysis of BLISS-76 trial. At each clinic, an expert classified patients in three categories: remission, mild or moderate/severe activity. The SLE-DAS cut-offs were derived using the receiver operating characteristic curve analysis in Padova cohort; its performance was assessed against expert classification in Cochin cohort and British Isles Lupus Assessment Group (BILAG) index in BLISS-76. Gold standard for clinical remission state was the fulfilment of Definition Of Remission In SLE. A Boolean and an index-based definitions of remission were sustained by chi-square automatic interaction detection algorithm. An SLE-DAS online calculator was developed and tested.ResultsWe included 1190 patients with SLE: 221 in the derivation cohort and 969 in the validation cohorts (150 from Cochin; 819 from BLISS-76). Derived cut-offs were: remission, SLE-DAS ≤2.08; mild activity, 2.087.64. Regarding validation in Cochin cohort, sensitivity and specificity are above 90%, 82% and 95% for remission, mild and moderate/severe activity, respectively. The SLE-DAS Boolean-based and index-based remission showed sensitivity of 100% and specificity above 97%.ConclusionThe SLE-DAS is an accurate and easy-to-use tool for defining SLE clinical remission state and disease activity categories, validated against expert assessment and BILAG.

Background:Treatment of systemic lupus erythematosus (SLE) is tailored according to the intensity of SLE disease activity and aims to achieve remission. Current definitions of remission and disease activity categories are mostly based on the SLE Disease Activity Index (SLEDAI), which has important limitations. The SLE Disease Activity Score (SLE-DAS) is a validated continuous disease activity score with higher accuracy in measuring SLE activity and higher sensitivity-to-change as compared to SLEDAI1. SLE-DAS is user-friendly with its online calculator.Objectives:To derive and validate the SLE-DAS cut-off values for defining SLE disease activity categories and SLE clinical remission state.Methods:Derivation study was conducted at the Padova Lupus Clinic. Validation was performed prospectively in patients from the Cochin Lupus Clinic and by post-hoc analysis of BLISS-76 (NCT00410384) trial. Gold-standard for clinical remission state was fulfillment of Definition Of Remission In SLE (DORIS). In Padova and Cochin Clinics, at time of inclusion, a senior clinician classified each patient as presenting: (i) remission, (ii) mild, or (iii) moderate/severe disease activity. Derivation of the SLE-DAS cut-offs for disease activity categories was performed using ROC curve analysis against this expert clinical classification. Performance of these SLE-DAS categories of disease activity was assessed as compared with: (i) expert classification (in Cochin cohort); (ii) British Isles Lupus Assessment Group (BILAG) index (in BLISS-76). An index-based and a Boolean definition of remission were tested applying decision trees, using CHAID (chi-square automatic interaction detection) algorithm and their performance estimated.Results:We included 1190 SLE patients (221 in Padova, 150 in Cochin and 819 from BLISS-76 cohorts). In the derivation cohort, best SLE-DAS cut-off values for disease activity categories were: (i) remission, SLE-DAS≤2.08; (ii) mild activity, 2.087.10. Table 1 shows the performance of these SLE-DAS cut-offs. The SLE-DAS Boolean-based definition of remission (all SLE-DAS clinical items scores = 0 and prednisone ≤5mg/day) showed sensitivity and specificity of 100% in the derivation (Padova) and validation (Cochin) clinical cohorts. The SLE-DAS index-based definition of remission (SLE-DAS ≤2.08 and prednisone ≤5mg/day) presented sensitivity =100% and specificity =97.4% in the derivation and validation clinical cohorts. The SLE-DAS definitions of remission were fully substantiated by CHAID.Table 1.Performance of SLE-DAS cut-offs for remission and disease activity categories compared to physician’s classification and BILAG (n =1190).Disease activity categorySensitivity (%)Specificity (%)Accuracy (%)DerivationPadova CohortRemission(SLE-DAS≤2.08)99.397.198.6Mild Disease Activity(2.0874.298.995.5Moderate and Severe Disease Activity(SLE-DAS>7.10)97.496.796.8ValidationCochin CohortRemission(SLE-DAS≤2.08)99.193.998.0Mild Disease Activity(2.0882.699.296.7Moderate and Severe Disease Activity(SLE-DAS>7.10)100.098.698.7ValidationBLISS-76Remission and Mild Disease Activity§vs. Moderate and Severe Disease Activity§§ (SLE-DAS≤7.10 vs. >7.10)91.484.190.8§ Remission/Mild: No BILAG B or A scores§§ Moderate/severe: ≥1 BILAG B or A scoresConclusion:The SLE-DAS is an accurate and easy to use tool for defining clinical remission state and SLE disease activity categories, validated with both the expert assessment and BILAG.References:[1]Jesus D, et al. Derivation and validation of the SLE Disease Activity Score (SLE-DAS): a new SLE continuous measure with high sensitivity for changes in disease activity. Ann Rheum Dis 2019;78:365-71.Acknowledgements:The authors would like to thank GlaxoSmithKline (Uxbridge, UK) for granting access to the data from the BLISS-76 trial through the Clinical Study Data Request consortium.Disclosure of Interests:None declared

It was with great interest that we read the letter ‘SLE-DAS: Ready for routine use?’ by Mathew and coauthors.1 Mathew et al commented on our recent article reporting the derivation and validation of the Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS),2 which demonstrated a much higher sensitivity to change of SLE disease activity, as compared with SLE Disease Activity Index 2000 (SLEDAI-2K). Mathew et al ’s main concern is in regard of the SLE-DAS scoring of active lupus nephritis (LN). The SLE-DAS renal component is measured continuously, applying a logarithmic scale of proteinuria absolute value (to be scored only if above 500 mg/day and provided it is attributable to active LN). This is very different of the SLEDAI-2K renal component that comprises four dichotomous variables (proteinuria above 500 mg/day, pyuria, haematuria and urinary casts, each one scored solely as present or absent with a weight of 4 points if present and regardless of severity).3 In the derivation of the SLE-DAS, we modelled the renal component using longitudinal data of real patients with active LN from a large, well-characterised tertiary lupus cohort.4 5 The SLE-DAS with its continuous scoring of the absolute value of proteinuria amends risks of major bias of SLEDAI-2K regarding renal involvement. In patients with active LN, the …

We have sought to understand the current state of the art on smart tourism and on smart cities. Furthermore, we have sought to understand community awareness and the will to embrace innovation, as they are decisive factors to acquire base knowledge and overcome barriers in (soon to be) overpopulated cities and for those who are looking for a limited time culture experience - known as tourists. We live in an age where technology is increasingly present in our lives and provides us solutions to societal problems. Problems such as traffic, infrastructure and natural resources management, or even increasing citizens’ participation in governance, bringing them closer to decision-making. The objective is to understand the current level of people’s knowledge about the impact that technologies have on the society in which we live and their perception of the usefulness in solving these same problems. Therefore, an anonymous questionnaire was carried out (176 valid answers were received), as well as a focus group with two experts on the Smart Cities subject. What future is brought by those who live and breathe technology? Are people willing to accept a paradigm shift? This work is financed by the ERDF – European Regional Development Fund through the Operational Programme for Competitiveness and Internationalisation - COMPETE 2020 Programme and by National Funds through the Portuguese funding agency, FCT - Fundação para a Ciência e a Tecnologia within project POCI-01-0145-FEDER-031309 entitled “PromoTourVR - Promoting Tourism Destinations with Multisensory Immersive Media”. info:eu-repo/semantics/publishedVersion

Participation has featured in political agendas in recent decades and the domain of healthcare has not been indifferent to its appeal. Although emerging later than in other European regions, the involvement of civil society in healthcare decision-making procedures has proved one of the biggest challenges facing Southern European health systems. The health systems of the countries considered in this analysis - Italy, Portugal and Spain - underwent reforms that brought citizen participation to the forefront of the health system. Through national laws or health plans, each of these countries has recognised the need to promote participation in order to 'give a voice' to citizens in the health sector. Accordingly, a range of significant activities have been implemented in the region, although they have been developed unequally within national territories, at different paces and involving the mobilisation of different actors. This article focuses on the most relevant experiences of citizen participation designed and implemented in the three selected countries, describing their key features and potential, as well as the main critical issues and contradictions that have emerged over time. Particular emphasis is given to the impact of the current financial crisis on Southern European national health systems, especially in terms of participatory methods, the way in which citizen participation is progressing and civil society's reaction to these important changes.

Background In Portugal, the National Health Plan for 2012–2016 (1) and its extension to 2020 (2) consider citizenship-based strategies, including the involvement of patients/citizens and their representatives, as a key strategic axis to maximize health gains. However, actual policy initiatives and concrete actions have been limited to a couple initiatives without significant patient or public involvement. On the other side, several patient and citizen organizations (3–6) have been advocating for increased and meaningful involvement in health decision-making. Objectives To develop a Charter for Public Involvement in Health that is widely accepted and recognized by health stakeholders. Methods A working group was established with representatives from 13 patient organizations, 1 consumer organization and a research centre. A participatory action research methodology was used. The draft Charter was circulated for review and signature amongst more than 200 non-for-profit health-related organizations and over 50 key individuals publicly renowned for their work in health or public participation. The final version of the Charter was discussed with political and health stakeholders in a Forum held at the Portuguese parliament. Results A Charter for Public Involvement in Health, including the principles, scope, guidelines and means of participation was developed. In January 2017, 30 individuals (former and current political decision-makers, health care professionals, researchers and patients) and more than 82 non-for-profit health-related organizations (the majority being Portuguese disease-specific patient organizations) had signed the Charter. The conclusions of the Forum show that the Charter was recognized as a very important initiative to promote public involvement in health in Portugal. Challenges and barriers to further advancing patient and public engagement were also identified (e.g. political will, recognitions of patients as partners, patient empowerment, capacity-building, etc.). The Charter and the Forum were covered in the media and follow-up initiatives with health care professionals and hospital administrators are ongoing. Conclusions A patient-led Charter, developed by patient and consumer representatives, in collaboration with academia, and the public discussion with other health care stakeholders have proven successful to put public participation in the political and health care agenda. References Direcao-Geral da Saude – Ministerio da Saude. Plano Nacional de Saude 2012–2016. Lisboa, Portugal; 2012. Direcao-Geral da Saude – Ministerio da Saude. Plano Nacional de Saude – Revisao e Extensao a 2020. Lisboa, Portugal; 2015. European Patients Forum. The Value+ Policy Recommendations: Patient Involvement in Health Programmes and Policy [Internet]. Available from: http://www.eu-patient.eu/globalassets/projects/valueplus/doc_epf_policyrec.pdf. European Patients Forum. Patient Empowerment Campaign [Internet]. Available from: http://www.eu-patient.eu/campaign/PatientsprescribE/. International Alliance of Patients9 Organisations. Policy statement. Patient Involvement [Internet]. 2005. Available from: http://iapo.org.uk/sites/default/filesfiles/IAPO Policy Statement on Patient Involvement.pdf. Terzi A. The patients9 involvement in health policies in Europe. Roma; 2013. Disclosure of Interest S. Crisostomo Grant/research support from: Abbvie, Brustol-Meyers Squibb, Janssen, GSK, Pfizer, Roche and ViiV, M. Santos Grant/research support from: Abbvie, Brustol-Meyers Squibb, Janssen, GSK, Pfizer, Roche and ViiV, M. Serapioni: None declared, A. Matos: None declared, E. Mateus: None declared

This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies. O artigo examina o processo de restruturação dos serviços de emergência perinatal implementado pelo Ministério da Saúde em Portugal em 2006 e tem como objetivo analisar essa decisão controversa. Especial ênfase é dada aos protestos desencadeados no país contra essa medida, os atores envolvidos e os argumentos contra e a favor, de forma a compreender os conhecimentos e as experiências trazidos para discussão dos problemas suscitados pela decisão tomada e como diferentes formas de conhecimento podem ser conciliadas no âmbito de procedimentos democráticos. Além disso, explora a relevância da participação cidadã na formulação de políticas de saúde, incluindo aquela que emerge de relações conflitantes.