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Continuous measurement of cerebral blood flow velocity (CBFV) of the middle cerebral artery (MCA) using transcranial Doppler (TCD) and arterial blood pressure (ABP) monitoring enables assessment of cerebrovascular haemodynamics. Further indices describing cerebrovascular function can be calculated from ABP and CBFV, such as the mean index (Mxa) of cerebrovascular autoregulation, the 'time constant of the cerebral arterial bed' (tau), the 'critical closing pressure' (CrCP) and a 'non-invasive estimator of ICP' (nICP). However, TCD is operator-dependent and changes in angle and depth of MCA insonation result in different readings of CBFV. The effect of differing CBFV readings on the calculated secondary indices remains unknown. The aim of this study was to investigate variation in angle and depth of MCA insonation on these secondary indices. In eight patients continuous ABP and ipsilateral CBFV monitoring was performed using two different TCD probes, resulting in four simultaneous CBFV readings at different angles and depths per patient. From all individual recordings, the K-means clustering algorithm was applied to the four simultaneous longitudinal measurements. The average ratios of the between-clusters, sum-of-squares and total sum-of-squares were significantly higher for CBFV than for the indices Mxa, tau and CrCP (p < 0.001, p = 0.007 and p = 0.016) but not for nICP (p = 0.175). The results indicate that Mxa, tau and CrCP seemed to be not affected by depth and angle of TCD insonation, whereas nICP was.

Predictions of mortality may help in the selection of patients who benefit from intensive care. Endothelial dysfunction is partially responsible for many of the organic dysfunctions in critical illness. Reactive hyperaemia is a vascular response of the endothelium that can be measured by peripheral arterial tonometry (RH-PAT). We aimed to assess if reactive hyperaemia is affected by critical illness and if it correlates with outcomes. Prospective study with a cohort of consecutive patients admitted to an Intensive Care Unit. RH-PAT was accessed on admission and on the 7th day after admission. Early and late survivors were compared to non-survivors. The effect of RH-PAT variation on late mortality was studied by a logistic regression model. The association between RH-PAT and severity scores and biomarkers of organic dysfunction was investigated by multivariate analysis. 86 patients were enrolled. Mean ln(RHI) on admission was 0.580 and was significantly lower in patients with higher severity scores (p

Background: the incidence of nontuberculous mycobacteria (NTM) disease is increasing and its presentation and severity can vary. Treatment of NTM disease is long, requires multiple drugs and the overall outcome can be related to host factors. Aim: to identify the effect of the alcohol consumption on the treatment outcome, crude and adjusted for other host variables. Methods: a retrospective analysis of patients with NTM disease between 2003-2016 (data from the Portuguese National Epidemiological Surveillance Commission for TB). Logistic regression models assessed odds ratios (OR) with 95% confidence interval (CI) for an unsuccessful treatment outcome. Results: 610 patients were included, 540 (89%) had lung NTM disease. The average age was 58±18.2 years and 369 were male patients. Five hundred and seventeen (84.8%) patients finished treatment successfully (good outcome) and 93 (15.2%) died while in treatment (bad outcome). The crude OR for alcohol consumption was 3.48 (95% CI1.91-6.21 p Conclusion: after adjustment for potential risk factors, alcohol consumption was estimated to double the odds for an unsuccessful outcome. This underlines the need of close monitoring among patients with alcohol dependencies to improve treatment outcomes.

The influence of the vehicle in topical treatment adherence remains to be elucidated. The aim of this study is to analyze the influence of the pharmaceutical dosage form on adherence to topical treatment in psoriasis patients, taking into consideration the mechanical features. The adherence was evaluated in a sample of 102 psoriasis patients, followed for approximately 45 days. Adherence was calculated with a new combined methodology using a log and medication weights. The effect of the group formulation was evaluated using logistic regression models. A complex effect of the vehicle on adherence was found, mediated by the affected area. The adherence was significantly higher for patients applying gels and creams than for those using ointments, whenever the body area affected was extensive. The opposite was found when the affected area was small. Mechanical properties can partially explain the findings since gels and creams may be easier to apply. Patient beliefs and preferences regarding vehicles and their sensory attributes might also explain the results. It is noteworthy that adherence was strikingly low, with more than 75% non-adherent patients. This real-world evidence provides an insight for pharmaceutical industries and guidance for treatment prescription by physicians aiming to address the public health emergency of treatment non-adherence.

Treatment of drug-resistant tuberculosis (TB), which is usually less successful than that of drug-susceptible TB, represents a challenge for TB control and elimination. We aimed to evaluate treatment outcomes and to identify the factors associated with death among patients with MDR and XDR-TB in Portugal. We assessed MDR-TB cases reported for the period 2000-2016, using the national TB Surveillance System. Treatment outcomes were defined according to WHO recommendations. We identified the factors associated with death using logistic regression. We evaluated treatment outcomes of 294 MDR- and 142 XDR-TB patients. The treatment success rate was 73.8% among MDR- and 62.7% among XDR-TB patients (p = 0.023). The case-fatality rate was 18.4% among MDR- and 23.9% among XDR-TB patients. HIV infection (OR 4.55; 95% CI 2.31-8.99; p < 0.001) and resistance to one or more second-line injectable drugs (OR 2.73; 95% CI 1.26-5.92; p = 0.011) were independently associated with death among MDR-TB patients. HIV infection, injectable drug use, past imprisonment, comorbidities, and alcohol abuse are conditions that were associated with death early on and during treatment. Early diagnosis of MDR-TB and further monitoring of these patients are necessary to improve treatment outcome. This work was developed under the scope of the project NORTE-01-0145-FEDER-000013 and NORTE-01-0145-FEDER-000023, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) and projects PTDC/SAU-PUB/29521/2017. This work was partially supported by “Contratos-Programa” UIDB/50026/2020 and UIDB/04050/2020 funded by national funds through the FCT - Foundation for Science and Technology, I.P. OO is supported by the project NORTE-08-5369-FSE-000041, financed by the Operational Program NORTE 2020 and co-financed by the European Social Fund through a doctoral grant (UMINHO/BD/47/2016). This work was also supported by national funds through the FCT, I.P., under the project UIDB / 04750/2020.

Treatment of drug-resistant tuberculosis (TB) has become a major challenge for TB control worldwide and treatment outcomes are often suboptimal. Overall, the death rate reported by WHO was 15% among patients with multidrug-resistant tuberculosis (MDR-TB) and 26% among patients with extensively drug-resistant tuberculosis (XDR-TB). We aimed to evaluate treatment outcomes and to identify the factors associated with death among MDR- and XDR-TB patients. We studied all patients that started MDR/XD-TB treatment in Portugal from 2000 to 2016 (follow up December 2019). Logistic regressions were used to identify the factors associated with treatment outcomes. We assessed treatment outcomes of 294 MDR- and 142 XDR-TB patients. Among MDR-TB patients, the death rate was 18%. Injectable drugs use (OR 6.70; 95% CI 3.12–14.40) and comorbidities (OR 2.53; 95% CI 1.09–5.88) were the identified risk factors. Fourteen (26 %) patients died in the first 3 months of treatment, 36% of which were HIV-positive injecting drug users. Among XDR-TB patients, the death rate was 24%. Incarceration (OR 3.30; 95% CI 1.10–9.87) was the risk factor associated with death. Twelve (75%) prisoners were also injecting drug users. Three (9%) patients died in the first 3 months of treatment. Taking into account the identified risk factors associated with death, we need to readjust measures to enable earlier diagnosis and improve case management on specific population groups.

Background Knowledge of human immunodeficiency virus (HIV) status is essential to effectively manage both tuberculosis (TB) and HIV infection. This is why the World Health Organization (WHO) recommends routine HIV testing in all TB patients. Objective To determine the number of TB patients with unknown HIV status in Portugal and to identify the factors associated with unknown HIV status. Methods A retrospective study of all TB notifications from 2008 to 2014 in Portugal was conducted. A multiple logistic regression model was used to evaluate the association of sociodemographic and clinical factors with unknown HIV status. Results We examined the records of 18 445 patients with TB notification, 2402 of whom (13%) had unknown HIV status. Unknown HIV status was positively associated with age 65 years (adjusted odds ratio [aOR] 1.208, 95%CI 1.037-1.408) and extra-pulmonary TB (aOR 1.381, 95%CI 1.252-1.523), but negatively associated with unemployment (aOR 0.755, 95%CI 0.637-0.895), alcohol dependence (aOR 0.809, 95%CI 0.682-0.959) and drug dependence (aOR 0.566, 95%CI 0.449-0.713). Conclusion Risk perception is the most important barrier to complete knowledge of HIV status in TB patients in Portugal. Given the importance of HIV screening in TB patients, every effort should be made to ensure that all TB patients undergo HIV screening.

Background and Purpose— Aneurysmal subarachnoid hemorrhage (SAH) is characterized by important changes in the autonomic nervous system with potentially adverse consequences. The baroreflex has a key role in regulating the autonomic nervous system. Its role in SAH outcome is not known. The purpose of this study was to evaluate the association between the baroreflex and the functional 3-month outcome in SAH. Methods— The study used a prospective database of 101 patients hospitalized for SAH. We excluded patients receiving β-blockers or noradrenaline. Baroreflex sensitivity (BRS) was measured using the cross-correlation method. A good outcome was defined by a Glasgow Outcome Scale score at 4 or 5 at 3 months. Results— Forty-eight patients were included. Median age was 58 years old (36–76 years); women/men: 34/14. The World Federation of Neurosurgery clinical severity score on admission was 1 or 2 for 73% of patients. In the univariate analysis, BRS ( P =0.007), sedation ( P =0.001), World Federation of Neurosurgery score ( P =0.001), Glasgow score ( P =0.002), Fisher score ( P =0.022), and heart rate ( P =0.037) were associated with outcome. The area under the receiver operating characteristic curve for the model with BRS as a single predictor was estimated at 0.835. For each unit increase in BRS, the odds for a good outcome were predicted to increase by 31%. Area under the receiver operating characteristic curve for heart rate alone was 0.670. In the multivariate analysis, BRS (odds ratio, 1.312; 95% confidence interval, 1.048–1.818; P =0.018) and World Federation of Neurosurgery (odds ratio, 0.382; 95% confidence interval, 0.171–0.706; P =0.001) were significantly associated with outcome. Area under the receiver operating characteristic curve was estimated at 0.900. Conclusions— In SAH, early BRS was associated with 3-month outcome. This conclusion requires confirmation on a larger number of patients in a multicentre study.

The optimal chest tube type and size for drainage and chemical pleurodesis of malignant pleural effusions remains controversial. This retrospective study was conducted to compare the efficacy of conventional versus pigtail chest tube in the treatment of malignant pleural effusions. Patients submitted to chest tube drainage and slurry talc pleurodesis due to malignant pleural effusion in our pulmonology ward from 2012 to 2016 were eligible. According to the type of chest tube, they were divided into two groups: group I—conventional chest tube and group II—pigtail chest tube. Number of deaths, recurrence of malignant pleural effusion, and timelines associated with the procedures were reviewed and compared between groups. Out of the 61 included patients, 46 (75.4%) were included in group I and 15 (24.6%) in group II. Only one patient had pigtail chest tube obstruction, with posterior insertion of conventional chest tube. Death during hospital stay and up to 3 months, recurrence at 4 weeks, total duration of hospital stay, time from chest tube insertion to pleurodesis, and time from chest tube insertion to removal were not significantly different between the two groups (all p > 0.05). These findings suggest that pigtail chest tube can be an alternative on palliation, with no compromise in pleurodesis performance.

Introduction Tuberculosis notification in Portugal has decreased in the last few years. As a consequence of the economic crisis, emigration has increased and immigration has decreased. Immigrants are a risk group for tuberculosis. Most emigrants are 20–44 years old and belong to the age group most affected by tuberculosis. Objective To describe the decrease in tuberculosis notification in Portugal over the last years from a demographical point of view. Methods Mathematical analysis was performed to quantify the effect of the migration movements (separately and simultaneously) on tuberculosis notification in Portugal from 2008 to 2014. We calculated the estimated tuberculosis notification for each year during the period of study: 1) fixing immigration rate and tuberculosis rate in immigrants at 2008 values; 2) fixing emigration rate and tuberculosis rate in emigrants at 2008 values; 3) fixing both phenomenons at 2008 values. Results The differences between the observed and the estimated numbers were small (≤0.5 cases/100 000 inhabitants). Discussion Impact of the migration movements on tuberculosis notification rate does not seem to be significant when analyzed for each phenomenon individually and simultaneously, by our model. This might mean that we have to concentrate our efforts in other risk factors for tuberculosis.

To investigate whether reactive hyperemia measured by peripheral arterial tonometry correlates with markers of endothelial dysfunction and may be used to identify sepsis in critical illness.A prospective study was performed using a cohort of critically ill patients. Endothelial dysfunction was assessed on admission by quantifying reactive hyperemia-peripheral arterial tonometry and plasma levels of endothelin-1, soluble E-selectin, endocan and syndecan-1. Septic patients were compared to patients without evidence of infection.Fifty-eight septic patients were compared to 28 controls. The natural logarithm of reactive hyperemia-peripheral arterial tonometry was negatively correlated with cardiovascular comorbidities, disease severity and plasma levels of soluble E-selectin (p = 0.024) and syndecan-1 (p0.001). The natural logarithm of reactive hyperemia-peripheral arterial tonometry was lower in septic patients than in controls (0.53 ± 0.48 versus 0.69 ± 0.42, respectively). When adjusted for age, the multivariable model predicted that each 0.1-unit decrease in natural logarithm of reactive hyperemia-peripheral arterial tonometry increased the odds for infection by 14.6%. m.Reactive hyperemia-peripheral arterial tonometry is closely related to soluble E-selectin and syndecan-1, suggesting an association between endothelial activation, glycocalyx degradation and vascular reactivity. Reactive hyperemia-peripheral arterial tonometry appears to be compromised in critically ill patients, especially those with sepsis.Investigar se a hiperemia reativa correlaciona-se com marcadores de disfunção endotelial e pode ser utilizada para identificar sepse na doença crítica.Trata-se de estudo prospectivo em uma coorte de pacientes críticos. A disfunção endotelial foi avaliada quando da admissão, por meio da quantificação de hiperemia por tonometria arterial periférica e níveis plasmáticos de endotelina 1, E-selectina solúvel, endocana e sindecano 1. Os pacientes sépticos foram comparados com pacientes sem evidência de infecção.Cinquenta e oito pacientes sépticos foram comparados com 28 controle. O logaritmo natural da tonometria arterial periférica teve correlação negativa com comorbidades cardiovasculares, severidade da doença e níveis plasmáticos de E-selectina solúvel (p = 0,024) e sindecano 1 (p0,001). O logaritmo natural da tonometria arterial periférica foi mais baixo nos pacientes sépticos quando comparado com os de pacientes controle (0,53 ± 0,48 versus 0,69 ± 0,42, respectivamente) e, quando ajustado à idade, o modelo multivariado predisse que cada 0,1 de diminuição em unidades de logaritmo natural da tonometria arterial periférica levou a aumento de 14,6% na probabilidade de infecção.A hiperemia reativa avaliada por tonometria arterial periférica tem estreita relação com E-selectina solúvel e sindecano 1, o que sugere associação entre ativação endotelial, degradação de glicocálix e reatividade vascular. A hiperemia reativa por tonometria arterial periférica parece estar comprometida em pacientes críticos, especialmente os com sepse.

Purpose: The present study compared the Doppler flow pulsatility indices (PI) in the uterine arteries (UtA) during the puerperium between healthy women and those with stage-1 essential hypertension who had uncomplicated pregnancies and delivered by elective caesarean section. The change in the mean arterial pressure (MAP) and body mass index (BMI) over time was also assessed. Methods: A longitudinal and prospective study was performed in singleton pregnancies of 28 normotensive (NT) and 24 hypertensive (HT) women. The UtA-PI was measured immediately before caesarean section (time 0) and at 1 week (time 1) and 4 weeks (time 2) postpartum. The presence or absence of early diastolic notches was recorded. The change in the MAP, BMI, and UtA-PI over time and between the two populations was modelled through multivariate linear regression using the generalised least squares. Results: In both groups, the UtA-PI significantly increased from time 0 to time 1 (p\0.05) and time 2 (p\0.05). Stage-1 hypertension did not change the trend but did increase the UtA-PI magnitude (p\0.05). The presence of uterine artery notching increased over time, from 6 to 98 %, in both groups (p\0.001); however, in the HT group, at time 1, the majority of women exhibited positive notching [92 % (HT) vs 57 % (NT), p = 0.013]. Conclusions: Chronic stage-1 hypertensive women with normal pregnancy outcomes exhibited a progressively increasing postpartum UtA impedance. This trend also occurred in normotensive women, albeit at a significantly lower magnitude.

The growing concern with biodiversity loss has raised the attention on the importance of cities as habitats for a unique assemblage of plants and animals, particularly its public green spaces. Public green spaces, namely parks, gardens and green squares, are often too numerous to allow a detailed study of all of them. Due to their high heterogeneity, a random selection or a stratification based on few features would have consequences on the statistical validity of subsequent biodiversity analysis. Therefore, we aim to present a sampling methodology for public urban green spaces for the selection of a representative group that reflects the diversity of the original population. First, the stratification is based on a selection of variables considered relevant for biodiversity research and easy to evaluate, specifically total area, vegetation cover, impermeable area, water, age, dominant function and space character. Then, a clustering method, through finite mixture modelling, is applied to generate groups of similar green spaces. The application of the proposed sampling methodology was tested in Porto, Portugal. It aims to facilitate site selection for urban biodiversity surveys, in order to improve the accuracy and reliability of biodiversity analysis in public green spaces.

Objective: To compare longitudinal trends of cardiotocographic (CTG) parameters between small-for-gestational-age (SGA) and normal fetuses, from 24 to 41 weeks of pregnancy. Methods: A prospective cohort study was carried out in singleton pregnancies without fetal malformations. At least one CTG was performed in each of the following intervals: 24–26 weeks+6 days, 27–29 weeks+6 days, 30–32 weeks+6 days, 33–35 weeks+6 days, 36–38 weeks+6 days and ≥39 weeks. Tracings were analyzed using the Omniview-SisPorto® 3.6 system. Cases with a normal pregnancy outcome, including a birthweight ≥10th percentile for gestational age, were compared with two groups of SGA fetuses: with birthweight th percentile (SGArd percentile (SGA Results: A total of 176 fetuses (31 SGA) and 1256 tracings (207 from SGA fetuses) were evaluated. All CTG parameters changed significantly throughout pregnancy in the three groups, with a decreasing baseline and probability of decelerations, and an increasing average long-term variability (LTV), average short-term variability (STV) and accelerations. Baseline showed a more pronounced decrease (steeper slope) in SGA fetuses, being higher in these cases at earlier gestational ages and lower later in pregnancy. Average LTV was significantly lower in SGA Conclusion: A unique characterization of CTG trends throughout gestation in SGA fetuses was provided. A steeper descent of the baseline was reported for the first time. The findings raise the possibility of clinical application of computerized CTG analysis in screening and management of fetal growth restriction.

The association between diabetes mellitus (DM) and tuberculosis (TB) has been a matter of study worldwide, since it is assumed that DM triples the risk of TB [1]. Recent studies have found discrepant prevalence of DM among TB patients, ranging from 5.3% in Denmark [2] to 44% in India [3]. There is an urgent need to control both epidemics in order to achieve the World Health Organization (WHO) TB elimination goal [4]. To reach this goal, an integrated approach between TB elimination strategies and control of noncommunicable diseases that perpetuate the risk for TB is fundamental [5]. In a Portuguese TB cohort, diabetes mellitus was associated with older age and no HIV infection or drug consumption

The burden of tuberculosis in the Northern Region of Portugal remains high despite the implementation of risk group oriented strategies. Therefore characterization of the factors that relate to mortality among tuberculosis patients in this geographical region is relevant and explains the purpose of this study.Records in the national surveillance system for tuberculosis characteristics for patients living in the North of Portugal and who completed tuberculosis treatment between 2008 and 2012 were studied by means of a retrospective caseâcontrol study design. Simple and multiple regressions were performed in order to assess the relationship between patient demographic, clinical and social history data with patient survival.Male individuals over 45 years old with prior cancer (OR 4.63, 90% CI 2.66â8.04) and disseminated tuberculosis (OR 1.96, 90% CI 0.48â0.99) were identified as being those with the highest risk of death throughout tuberculosis treatment. Keywords: TB, Epidemiology, Predictors

Introduction: Immigrants may utilize health care services differently than other residents and may also have a greater risk for tuberculosis (TB). Objective: Identify barriers to healthcare access by immigrants, factors associated with these barriers, and discuss strategies that may reduce these barriers. Material and methods: Anonymous questionnaires were given to immigrants at National Immigrant Support Centres between 2015 and 2016. Barriers to healthcare were identified using logistic regression. Results: One-hundred and nineteen questionnaires were administered to immigrants, 9 of whom (8%) presented with TB while in Portugal. Twenty-one percent of immigrants reported barriers to healthcare access, and 69% had general practitioners (GPs). The presence of barriers to healthcare access was negatively associated with having a GP and with being married or in a de facto union. Conclusions: A considerable proportion of immigrants reported having difficulties accessing healthcare services in Portugal where legally these barriers are nonexistent. Certain factors were associated with these difficulties. Keywords: Tuberculosis, Immigration, Health services, Barriers

The Human Immunodeficiency Virus (HIV) is an infectious agent that attacks the immune system cells. Without a strong immune system, the body becomes very susceptible to serious life threatening opportunistic diseases. In spite of the great progresses on medication and prevention over the last years, HIV infection continues to be a major global public health issue, having claimed more than 36 million lives over the last 35 years since the recognition of the disease. Monitoring, through registries, of HIV-AIDS cases is vital to assess general health care needs and to support long-term health-policy control planning. Surveillance systems are therefore established in almost all developed countries. Typically, this is a complex system depending on several stakeholders, such as health care providers, the general population and laboratories, which challenges an efficient and effective reporting of diagnosed cases. One issue that often arises is the administrative delay in reports of diagnosed cases. This paper aims to identify the main factors influencing reporting delays of HIV-AIDS cases within the portuguese surveillance system. The used methodologies included multilayer artificial neural networks (MLP), naive bayesian classifiers (NB), support vector machines (SVM) and the k-nearest neighbor algorithm (KNN). The highest classification accuracy, precision and recall were obtained for MLP and the results suggested homogeneous administrative and clinical practices within the reporting process. Guidelines for reductions of the delays should therefore be developed nationwise and transversally to all stakeholders., A. Rita Gaio was partially supported by CMUP (UID/MAT/00144/2013), which is funded by FCT (Portugal) with national (MEC) and European structural funds (FEDER), under the partnership agreement PT2020. Luis Paulo Reis was partially by the European Regional Development Fund through the programme COMPETE by FCT (Portugal) in the scope of the project PEst - UID/ CEC/00027/2015 Luis Paulo Reis and Brigida Monica Faria were partially funded by QVida+: Estimacao Continua de Qualidade de Vida para Auxilio Eficaz a Decisao Clinica, NORTE-01-0247-FEDER-003446, supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement.

Setting: Confirmation of tuberculosis (TB) in children is difficult, so clinicians use different procedures when deciding to treat. Objective: Identify criteria to initiate and maintain TB treatment in children younger than 5 years-old, without diagnosis confirmation. Design: A web-based survey was distributed by email to the corresponding authors of journal articles on childhood TB. The observations were clustered into disjoint groups, and analyzed by Ward's method. Results: We sent out 260 questionnaires and received 64 (24.6%) responses. Forty-six respondents (71.9%) said that microbiological confirmation was not important for initiation of anti-TB treatment, and that the epidemiological context and signs/symptoms suggestive of disease were most important. Sixty-one respondents (95.3%) said that the decision to continue therapy was mainly dependent on clinical improvement. A cluster of older respondents (median age: 52 years-old) who were active at a hospital or primary health care centre placed the most value on immunological test results and chest X-rays. A cluster of younger respondents (median age: 38 years-old) who were less experienced in management of TB placed more value on Interferon Gamma Release Assay (IGRA) results and chest computed tomography (CT) scans. A cluster of respondents with more experience in treating TB and working at specialized TB centres placed greater value on the clinical results and specific radiological alterations (“tree-in-bud” pattern and pleural effusion). Conclusion: TB management varied according to the age, work location and experience of the clinicians. It is necessary to establish standardized guidelines used for the diagnosis and decision to treat TB in children. Rita Gaio and Fábio Ferreira were partially supported by CMUP (UID/MAT/00144/2013), which is funded by FCT (Portugal) with national (MEC) and European structural funds (FEDER), under the partnership agreement PT2020.

Self-report measures are the most used methodologies for the evaluation of adherence to psoriasis topical treatment, although currently there is no standard questionnaire for this purpose. The present study aimed at developing a novel questionnaire (Questionnaire for Adherence to TOPical treatment [QATOP]) for the assessment of adherence to topical treatment in psoriasis. A questionnaire containing nine items organized into two parts (part 1: current patient treatment; part 2: adherence to treatment, amount used, and treatment-associated variables) was developed, supported by a systematic literature review, qualitative patient focus interviews, and expert-group input. Its content validity was determined by a pilot study of six patients. Adherence to topical treatment was then assessed in 35 patients with psoriasis, after 45 days of treatment, using the QATOP and a medication log. Associations between different items of the QATOP and the log were investigated. Adherence results were 63.5 ± 29.2% for the log and 60.9 ± 24.4% for the QATOP, and were strongly correlated (R = 0.819, p

Institutions should have more effective TB screening and HCWs should receive training to make informed decisions

In theory the formula scoring methods increase the reliability of multiple-choice tests in comparison with number-right scoring. This study aimed to evaluate the impact of the formula scoring method in clinical anatomy multiple-choice examinations, and to compare it with that from the number-right scoring method, hoping to achieve an evidence-based decision about test scoring rules. Two hundred and ninety-eight students completed an examination in clinical anatomy which included 40 multiple-choice questions with five response options each. Among these, 245 (82.2%) examinees were assessed according to the number-right scoring method (group A) while 53 (17.8%) were assessed according to the formula scoring method (group B). The prevalence of passing was significantly higher in group A than in group B, after correction of the pass and fail cutoffs for guessing (84.9% vs. 62.3%, P = 0.005), keeping a similar reliability in both groups (0.7 vs. 0.8, P = 0.094). Pearson Correlation coefficients between practical and theoretical examination scores were 0.66 [95%CI = (0.58–0.73)] and 0.72 [95%CI = (0.56–0.83)] for groups A and B, respectively. Based solely on the reliability and validity assessments, the test-maker could therefore use either scoring rules; however, if the test-maker also takes into account the students' ability to deduce answers with partial knowledge, then the number-right score rule is most appropriate. Anat Sci Educ 8: 242–248. © 2014 American Association of Anatomists.

Objective The aim of the study was to construct gestational age-based reference ranges for the uterine artery (UtA) mean pulsatility (PI) and resistance (RI) indices from 6 to 10 weeks of pregnancy. Method A prospective, cross-sectional, observational study was carried out in 312 singleton pregnancies with gestational age ranging from 6 to 10 weeks. UtAs were examined transvaginally by color and pulsed Doppler imaging, and the mean of the right and left values of PI and RI, as well as the presence or absence of a bilateral protodiastolic notch, was recorded. UtA-PI and UtA-RI reference percentiles were derived through time-conditional quantile regression. Results The authors derived the 10th, 50th, and 90th reference percentile curves and correspondent 95% confidence intervals, for the evolution of the UtA mean PI and RI from week 6 to week 10 of gestation. The prevalence of bilateral notching absence was 8.1% (6/74) at 6 weeks and 28.8% (15/52) at 10 weeks. Conclusion The authors present evidence of progressive reduction of uterine vascular impedance in a very early stage of pregnancy and provide new, averaged UtA-PI and UtA-RI charts between 6 and 10 weeks of gestation. © 2014 John Wiley & Sons, Ltd.

BACKGROUND: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. OBJECTIVES: To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless. DESIGN: This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression. RESULTS: TB incidence among the homeless was 122/100 000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection. CONCLUSION: TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal., CONTEXTE : La tuberculose (TB) est un souci majeur dans les populations à haut risque comme les personnes sans domicile fixe. OBJECTIFS : Evaluer le taux d’incidence de la TB et les resultats du traitement parmi des patients sans domicile fixe au Portugal et identifier les facteurs de préediction d’ échec du traitement de la TB parmi ces patients. SCHÉMA : Etude rétrospective de cohorte incluant tous les patients TB notifies au Portugal entre 2008 et 2014. Les caractéristiques des patients sans domicile fixe ont été ́évaluées et les facteurs de prédiction d’ échec du traitement de la TB ont été déterminés par ŕegression logistique. RESULTATS : Le taux d’incidence de la TB parmi les personnes sans domicile fixe a été de 122/100 000, et il a été positivement corrélé avec l’incidence de la TB parmi le reste de la population. Les patients tuberculeux sans domicile fixe avaient une prévalence plus élevée de consommation d’alcool et/ou de drogues, de co- infection au virus de l’immunodéficience humaine (VIH), de forme caverneuse et de frottis positif. Le taux d’ ́echec du traitement a ́et ́e de 28,6% ; l’ ́echec a ́ et ́esignificativement associé à un âge plus avancé, à la consommation de drogues injectables et à la co-infection par le VIH. CONCLUSION : L’incidence dela TB parmi les personnes sans domicile fixe a été cinq fois plus élevée que celle du reste de la population et plus haute dans les régions ou l’incidence dans le reste de la population est egalement plus élevée. Leur taux d’ échec du traitement à été plus faible. Les facteurs de prédiction d’ échec du traitement ont été l´âge, la consommation de drogues injectables et la co-infection `a VIH. Des programmes de TB intégrés ciblant les patients sans domicile fixe et les autres, avec des mesures spécifiques adaptées à leurs caractéristiques particulières, pourrait contribuer à l’ élimination de la TB au Portugal., MARCO DE REFERENCIA: La tuberculosis (TB) constituye una gran preocupación en las poblaciones muy vulnerables como las personas sin hogar. OBJETIVOS: Evaluar la tasa de incidencia de TB y los desenlaces terapéuticos en las personas sin domicilio en Portugal y definir los factores pronósticos de fracaso terapéutico en este grupo de la población. MÉTODO: Fue este un estudio retrospectivo de cohortes de todos los pacientes con diagnóstico de TB notificados del 2008 al 2014 en Portugal. Mediante un análisis de regresión logística se analizaron las características de los pacientes tuberculosos sin hogar y los factores pronósticos de fracaso terapéutico. RESULTADOS: La tasa de incidencia de TB en la población sin hogar fue 122 por 100 000 personas y exhibió una correlación positiva con la incidencia de TB en las personas con domicilio. Los pacientes con diagnóstico de TB y sin hogar presentaron una prevalencia más alta de consumo de alcohol y/o de drogas, de coinfección por el virus de la inmunodeficiencia humana (VIH), de lesiones cavernosas y de resultados positivos de la baciloscopia. La tasa de fracaso terapéutico en esta población fue 28,6% y se asoción de manera significativa con una mayor edad, el consumo de drogas intravenosas y la coinfección por el VIH. CONCLUSIÓN: La incidencia de TB en las personas sin hogar fue cinco veces mayor que en las personas con domicilio y fue más alta en las regiones con una mayor incidencia de TB en las personas con domicilio. La tasa de éxito terapéutico en las personas sin hogar fue más baja. Los factores pronósticos de fracaso terapéutico fueron la edad, el consumo de drogas intravenosas y la coinfecció non por el VIH. La ejecución de programas integrados de atención de la TB dirigidos a las personas sin hogar y con domicilio, que comporten medidas específicas que aborden sus características particulares, podrıa contribuir a la eliminación de la TB en Portugal, Study Group for Infectious Diseases of Instituto de Saúde Púublica da Universidade do Porto who collaborated on this project: B Miranda, C Carvalho, C Matos, C Carvalho, G Rodrigues, J Goncalves, L Maio and T Rito. This work was supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants under the Public Health Initiatives Programme (PT 06, grant number 138DT1). RG was also partially supported by Centro de Matemática da Universidade do Porto (UID/MAT/00144/2013), which is funded by Fundação do Ministério de Ciência e Tecnologia(Portugal) with national (MEC) and European structural funds (Fonds europeen de d ́eveloppement economique et regional) under the PT2020 Partnership Agreement, info:eu-repo/semantics/publishedVersion

Setting: Portugal has the highest tuberculosis incidence in Western Europe and in two small northern regions it is more frequently associated with silicosis. Objective: The aim of the present study was to characterize the risk factors associated with silico-tuberculosis and non-silico-tuberculosis patients within the tuberculosis population between 1 January 1999 and 31 December 2012 in Portugal and to identify the possible differences in the diagnosis, treatment and outcome. Design: The study used the surveillance tuberculosis system database and a logistic regression analysis enhanced with boostrapping. Results: In the 13 years studied period, 16581 patients were diagnosed with TB - 205 with silicosis and 16376 without. Almost all (99%) of the silicotic population was male and lived in northern Portugal. When comparing both populations, the silicotuberculosis was more prone to being male (0 Conclusion: TB in silicotic patients is more difficult to diagnose and treat, emerging in older groups with no other risk factors for TB. TB awareness must be raised among medical doctors, especially among occupational health services.

Tuberculosis (TB) is a major global health problem. Over the last 20 years, although industrialized countries have shown changes in overall TB notifications with decreasing incidence in native population and increasing incidence in foreign-born populations. The objective was to characterize the risk factors associated with TB among native and foreign-born tuberculosis patients between 1 January 2008 and 31 December 2012 in Portugal. Retrospective case-control study was done to characterize the risk factors associated with tuberculosis among native and foreign-born population in Portugal. The medical records of all TB cases notified between the 1 january 2008 and 31 december 2012 were analysed. We analyzed 2092 foreign-born and 4294 native-born patients. 1362 (65%) of the foreign-borns were male with mean age 35.99 years (± 15.78). The native population had 2722 males (63%) with mean age 45.34 (± 20.86). HIV positivity [adjusted odds ratio (OR):2.143; 95% CI: 1.643-2.796], was the risk factor more frequently found in foreign-born cases; drug abuse was less frequently found in foreign-born cases (OR: 0.328; 95% CI: 0.229-0.470) and employment was more frequent among the foreign born group (OR: 1.458 95% CI: 1.204-1.764). The outcome of the disease and the time between the onset of symptoms and diagnosis were not statistically different between the 2 groups (p=1). The outcome and the period between symptom and diagnosis did not differ between the two studied groups. The risk factors associated with TB cases are different between the two populations. There is a need to define different strategies in these two populations.

Background: Portugal remains the country with the highest tuberculosis (TB) incidence in Western Europe. Understanding the effect of the population9s profile on TB notification rate can have important public health implications. Objectives: This study aims to identify longitudinal trends of TB incidence in Portugal from 2002 to 2012 and to investigate the effect of the sociodemographic and health characteristics of the resident population on the identified time profiles. Methods: We used data from national Tuberculosis Surveillance System and other national institutions. The K-means longitudinal clustering algorithm was performed on the time profiles of TB notification rates from each of the 19 evaluated regions. The average evolution of TB notification rate was modelled as a linear function of the following factors: time (in years), the 3-cluster structure, population density, HIV notification rate, unemployment, incarceration, prison overcrowding, alcohol or drugs, working age population, elderly population, medical doctors, medical appointments and interactions of these covariates with the cluster structure. The fitting process used generalized least squares. Results: HIV notification rate and population density were shown to have significant effects on the TB notification rate. In particular, it is expected that an increase of 10 HIV notifications will lead to a rise of 2.5 TB notifications, for a fixed cluster, year and population density value. Conclusions: Our study supports that strategies to reduce the HIV incidence and the HIV/TB co-infection, in addition to targeted programs for regions with high population density, should decrease TB notification rate.

BACKGROUND: Cyclic endometrial neoangiogenesis contributes to changes in local vascular patterns and is amenable to non-invasive assessment with Doppler sonography. We hypothesize that the uterine artery (UtA) impedance, measured by its pulsatility index (PI), exhibits a regular pattern during the normal menstrual cycle. Therefore, the main study objective was to derive normative new day-cycle-based reference ranges for the UtA-PI during the entire cycle from days 1 to 34 according to the isolated time effect and potential confounders such as age and parity. METHODS: From January 2009 to December 2012, a cross-sectional study of 1,821 healthy women undergoing routine gynaecological ultrasound was performed. The Doppler flow of the right and left UtA-PI was studied transvaginally by colour and pulsed Doppler imaging. The mean right and left values and the presence or absence of a bilateral protodiastolic notch were recorded. Reference intervals for the PI according to the cycle day were generated by classical linear regression. RESULTS: The majority of patients (97.5%) presented unilateral or bilateral UtA notches. The crude 5th, 50th, and 95th reference percentile curves of the UtA-PI at 1-34 days of the normal menstrual cycle were derived. In all curves, a progressive significant decrease occurred during the first 13 days, followed by an increase and recovery in the UtA-PI. The adjusted 5th, 50th, and 95th reference percentile curves for the effects of age and parity were also obtained. These two conditions generated an approximately identical UtA-PI pattern during the cycle, except with small but significant reductions at the temporal extremes. CONCLUSIONS: The median, 5th, and the 95th percentiles of the UtA-PI decrease during the first third of the menstrual cycle and recover to their initial values during the last two thirds of the cycle. The rates of decrease and recovery depend significantly on age and parity.

To the Editor: Despite progress in tuberculosis (TB) control, the response to the multidrug- resistant (MDR) TB and extensively drug-resistant (XDR) TB epidemic continues to be limited. The proportion of MDR-TB patients who successfully completed treatment varied from 44% (Eastern Mediterranean Region) to 58% (South-East Asia Region) [1]. Overall, treatment success was 48%, while 28% of cases were reported as lost to follow-up or had no outcome information [1]. The Global Plan's target for 2015 of achieving at least 75% treatment success in MDR-TB patients was only reached by 30 out of 107 countries [1]. In the present paper, we evaluated the treatment outcomes of M/XDR-TB patients in Portugal. Patients with pulmonary TB resistant to isoniazid and rifampin, who started treatment at some point between January 2000 and December 2008, were selected from the national database, which integrates the data from the mandatory registration of TB cases. The evaluation of treatment outcomes was conducted from February to April 2011. Patients were classified as having received no previous treatment for TB or as having received previous treatment(s) for TB. The World Health Organization (WHO) standard definitions were used to MDR-TB, XDR-TB and treatment outcome (treatment success, died, failure, default and transferred out) [1, 2]. Was analysed the relationship between treatment outcome and clinical and demographic factors. It were also identified the predictors of poor outcome in a population of M/XDR-TB patients. The association between explanatory variables and …

To the Editor: Contact screening, as a strategy to identify recently infected individuals, is part of the tuberculosis (TB) elimination strategy. It follows risk stratification concerning the infectiousness of the index patient, the duration and proximity of exposure, and the susceptibility of the contact [1, 2]. For its optimisation it is important to know which risk factors are associated with Mycobacterium tuberculosis transmission in order to not over screen or lose at-risk contacts. In view of that, this study aims to identify potential risk factors for M. tuberculosis transmission among contacts of pulmonary TB patients, in a Portuguese TB reference centre. From January to December of 2011, all contacts of confirmed pulmonary TB patients, screened in the TB centre, were questioned about their exposure to the index patient through a questionnaire completed during the medical appointment. Both household and casual contacts were screened, independent of their cumulative exposure. Contacts excluded: those with exposure outdoors ( e.g. in the street); those with incomplete characterisation of exposure ( e.g. index patients for whom we did not know the symptomatic period); those non-compliant with screening ( e.g. contacts who failed tuberculin skin test (TST) reading); and those with a past history of M. tuberculosis infection or TB disease ( e.g. contact´s verbal report of previous TB disease, contact with a pulmonary TB patient or treatment for latent tuberculosis infection (LTBI)). Contacts of patients with a diagnosis of pulmonary TB were identified for screening at the moment of the index patient diagnosis. The index patient was asked to identify contacts within the family, social and work spheres. Furthermore, some other …

Objective The aim of this study was to identify dietary patterns in 13-y-old adolescents and to evaluate their association with socioeconomic and behavioral factors. Methods Data from 1489 adolescents born in 1990 and enrolled in schools of Porto, Portugal, in 2003–2004 (EPITeen study) were analyzed, after excluding those without information on the food frequency questionnaire and the outliers. The questionnaire items were grouped into 14 food groups and dietary patterns were identified by cluster analysis (k-means). Their association with participants' characteristics was computed using multinomial logistic regression. Results Four dietary patterns were identified. The pattern healthier (16.1%) was characterized by the highest consumption of seafood, soup, vegetables/legumes, fruit, and added fats. The dairy products pattern (29.7%) showed the highest consumption of dairies. The pattern fast food and sweets (14.2%) presented the highest intake of fast food, sweets and pastry, soft drinks and coffee or tea. The lower intake pattern (40%) was characterized by a lower consumption of the majority of food groups. A higher odds of belonging to the fast food and sweets pattern, compared with the lower intake pattern was found among adolescents spending more time watching TV on the weekends (>360 min: odds ratio [OR], 2.09; 95% confidence interval [CI], 1.23–3.57) and among those consuming four to seven fried meals per week (OR, 3.96; 95% CI, 2.27–6.90). Adolescents with highly educated parents were less likely to belong to the fast food and sweets group. Conclusion Unhealthier behaviors and lower socioeconomic position were the main factors associated with the unhealthier dietary pattern (fast food and sweets). This information should be considered in the development of health-promotion interventions.

Purpose: Dietary pattern analysis may uncover the joint effects of multiple dietary components on bone health, but such research is scarce and targets mostly adults. Methods: We quantified prospective associations between dietary patterns and bone mineral density (BMD) in 1,007 adolescents of a cohort born in 1990 and recruited at schools in Porto during the 2003/2004 school year. Forearm BMD was measured using dual-energy X-ray absorptiometry. Participants’ dietary patterns were classified “Healthier”, “Dairy products”, “Fast food and sweets” and “Lower intake” according to previously identified patterns obtained in a larger sample of 1,489 participants using the K-means method. Using dietary patterns at 13 years old as the main exposure, associations were estimated cross-sectionally (with BMD at the age of 13) and prospectively (with annual BMD variation between 13 and 17 years), using linear regression coefficients adjusted for height, weight, energy intake and, in girls, for menarche age. Results: No significant associations between the a posteriori dietary patterns identified and mean BMD at 13 were found. However, among girls, adherence to a pattern characterized by low intake of energy and all food groups was negatively associated with annual BMD variation between 13 and 17 years [adjusted coefficient (95 % CI) −0.451 (−0.827; −0.074) mg·cm−2·year−1]. Conclusions: Although results showed that, in girls, adherence to a “Lower intake” dietary pattern is associated with lower annual BMD variation throughout adolescence, overall, there were no consistent associations between dietary patterns and forearm BMD in adolescents.

Kidney hyperfiltration with augmented renal clearance is frequently observed in patients with traumatic brain injury. The aim of this study is to report preliminary findings about the relationship between brain autoregulation impairment, estimated kidney glomerular filtration rate and outcome in critically ill patients after severe traumatic brain injury. Data collected from a cohort of 18 consecutive patients with severe traumatic brain injury managed with ICP monitoring in a Neurocritical Care Unit, were retrospectively analyzed. Early morning blood tests were performed for routine chemistry assessments and we analyzed creatinine and estimated creatinine clearance, osmolarity, and sodium. Daily norepinephrine dose, protein intake, and water balance were documented. Time average of brain monitoring data (intracranial pressure, cerebral perfusion pressure, and cerebrovascular reactivity pressure index—PRx) were calculated for 6 h before blood sample tests. Patient outcome was evaluated using Glasgow outcome scale at 6-month follow-up, considering nonfatal outcome if GOS ≥3 and fatal outcome if GOS

The Human Immunodeficiency Virus can evolve to severe illness having a major impact on socio-demographic and economic features of the affected countries. Most countries rely on surveillance systems to monitor the status of the epidemic which are based on cases notification by physicians. It can take several months until the diagnosed cases are notified and there are even cases that are not reported at all. The purpose of this paper is to adjust the Portuguese notification data to these main possible biasing problems. For the reporting delay we will use the traditional conditional likelihood estimation for count data assuming a Poisson distribution. For the cases that are not reported at all, we will use a mixture of Poisson distributions, based on natural conjugate prior distributions, and estimate the unknown parameters through maximum likelihood. The Poisson model suggests that approximately 80% of the Portuguese AIDS cases were reported within one year after the diagnosis and that the majority of cases were notified in the first three months. The BB/NBD model suggests that the probability of a new AIDS case being notified gets higher once a large amount of AIDS cases has been notified.

Background: The foetal aortic Doppler frequency spectrum is influenced by cardiac output and contractility of the foetal heart as well as vascular compliance, blood viscosity and impedance of the arterial vascular system. The present study aimed at comparing Doppler flow pulsatility (PI) and resistance (RI) indexes of foetal proximal descending aorta (AoF) in the first, second and third trimesters of pregnancy, in low risk women and in those with chronic arterial hypertension, who had normal pregnancy outcomes. Methods: A longitudinal and prospective study was carried out in 101 singleton pregnancies (71 low-risk pregnancies and 30 with essential hypertension). Multivariate regression had to be considered due to the experiment’s nature: two different indexes were read on the same set of individuals, once at each trimester of the pregnancy [1st (11–14 weeks), 2nd (19–22 weeks) and 3rd (28–32 weeks) trimesters]. The response variable was denoted as index d, in a subject with hypertensive status h (hypertensive or normotensive), at continuous time t. Results: In both groups, AoF-PI and AoF-RI showed a small, but significant increase from the first to the second (1.850 ± 0.339 vs 2.110 ± 0.242 for PI, and 0.829 ± 0.068 vs 0.857 ± 0.038 for RI; p < 0.001) and the first to the third (1.850 ± 0.339 vs 2.163 ± 0.282 for PI, and 0.829 ± 0.068 vs 0.864 ± 0.037 for RI; p < 0.001) trimesters of pregnancy. The global model showed that while AoF-RI trends were converging as time progressed, the AoF-PI values exhibited a divergent trend (p < 0.05). Conclusions: Chronic stable hypertension in pregnancies with normal outcome, evidences an upward regular trend of foetal descending aorta pulsatility index that is similar to the normotensive condition.

The objective of this work was to compare Doppler flows pulsatility index (PI) and resistance indexes (RI) of uterine and internal iliac arteries during pregnancy in low risk women and in those with stage-1 essential hypertension. From January 2010 and December 2012, a longitudinal and prospective study was carried out in 103 singleton uneventful pregnancies (72 low-risk pregnancies and 31 with stage 1 essential hypertension)at the 1st, 2nd and 3rd trimesters. Multiple linear regression models, fitted using generalized least squares and whose errors were allowed to be correlated and/or have unequal variances, were employed; a model for the relative differences of both arteries impedance was utilized. In both groups, uterine artery PI and RI exhibited a gestational age related decreasing trend whereas internal iliac artery PI and RI increased. The model testing the hemodynamic adaptation in women with and without hypertension showed similar trend. Irrespective of blood pressure conditions, the internal iliac artery resistance pattern contrasts with the capacitance pattern of its immediate pelvic division, suggesting a pregnancy-related regulatory mechanism in the pelvic circulation.

About one-third of the population worldwide have Mycobacterium tuberculosis infections, although 90% of infected individuals never develop clinical disease [1, 2]. Heavy alcohol intake seems to increase risk of TB in males. New measures for alcohol abuse are needed The author's contributions are as follows. Conception and design: R. Duarte and O. Oliveira; analysis and interpretation: J. Francisco, O. Felgueiras, A.R. Gaio and R. Duarte; drafting the manuscript for important intellectual content: J. Francisco, O. Oliveira, A.R. Gaio and R. Duarte.

Background There is scarce evidence regarding the association between diet and metabolic syndrome (MetS) in Portuguese population. We aim to evaluate the association between a posteriori dietary patterns (DPs) and MetS and its features. Methods Using random digit dialing, a sample of 2167 adults was selected between 1999 and 2003, in Porto. During a face-to-face interview, a questionnaire was applied, anthropometric measures were taken, blood pressure measured and a fasting blood sample collected. Diet was assessed using a validated food frequency questionnaire, and four DPs were identified in each sex by multivariate finite mixture models. Results After adjustment for age and daily energy intake, comparing to the “healthy” DP, women with the “low fruit and vegetables” DP had a higher odds of high waist circumference (OR = 1.88 95% CI 1.17-3.01) and low HDL-cholesterol (OR = 1.78 95% IC 1.12-2.82) and women in the “red meat and alcohol” DP had higher odds of high waist circumference (OR = 1.45 95% CI 1.01-2.07) and of MetS (OR = 1.57 95% CI 1.07-2.29); men with the “fish” DP had a higher odds of high triglycerides (OR = 1.57 95% CI 1.05-2.35). After further adjustments (education, physical activity, smoking, alcohol drinking, BMI, and menopausal status) no significant associations remained. Conclusions Four distinct DPs were identified in a community sample of Portuguese adults and there was no association with the prevalence of MetS.

Background Previous studies showed an inter-observer agreement for the NYHA classification of approximately 55%. The aim of this study was to calibrate the New York Heart Association (NYHA) classification system between observers, increasing its reliability. Results Among 1136 community-dwellers in Porto, Portugal, aged ≥ 45 years, 265 reporting breathlessness answered a 4-item questionnaire to characterize symptom severity. The questionnaire was administered by 7 physicians who also classified the subject's functional capacity according to NYHA. Each subject was assessed by one physician. We calibrated NYHA classifications by the concurrent method, using 1-parameter logistic graded response model. Discrepancies between observers were assessed by differences in ability thresholds between NYHA classes I-II and II-III. The ability estimated by the model was used to predict the NYHA classification for each observer. Estimates of the first and second thresholds for each observer ranged from -1.92 to 0.46 and from 1.42 to 2.30, respectively. The agreement between estimated ability and the observers' NYHA classification was 88% (kappa = 0.61). Conclusions The study objectively indicates the main reason why several studies have reported low inter-observer is the existence of discrepant thresholds between observers in the definition of NYHA classes. The concurrent method can be used to minimize the reliability problem of NYHA classification.

Background To identify incorrect beliefs and common knowledge about rheumatic diseases in the general population. Methods Participants were selected during the follow-up of a representative cohort of adult population of Porto, Portugal; 1626 participants completed a questionnaire that included general knowledge items about rheumatic diseases. Discrete and continuous latent variable models were used to identify knowledge flaws and the target groups. Odds ratios (OR) estimated by multinomial logistic regression, and 95% confidence intervals (95%CI) were computed to evaluate magnitude of associations. Results A continuous latent variable model identified two dimensions: one related to general beliefs (latent 1) and another concerning characteristics, treatment and impact of rheumatic diseases (latent 2). A 3-class latent variable model refined these results: the first class presented the lowest probabilities of correct answer for items associated with the first latent (mean of 39%), and the second class presented the lowest probabilities of correct answer for items with the second latent (mean of 62%). The third class showed the highest probability of a correct answer for almost all the items (mean of 79%). The age and sex standardized prevalence of the classes was 25.7%, 30.8% and 43.5%. Taking class 2 as reference, class 1 was positively associated with the presence of rheumatic diseases (OR = 2.79; CI95% = (2.10-3.70)), with females (OR = 1.28 CI95% = (0.99-1.67)) and older individuals (OR = 1.04; CI95% = (1.03-1.05)), and was negatively associated with education (OR = 0.84; CI95% = (0.81-0.86)); class 3 was positively associated with education (OR = 1.03; CI95% = (1.00-1.05)) and the presence of rheumatic diseases (OR = 1.29; CI95% = (0.97-1.70)). Conclusions There are several knowledge flaws about rheumatic diseases in the general public. One out of four participants considered false general beliefs as true and approximately 30% did not have detailed knowledge on rheumatic disease. Higher education and the presence of disease contributed positively to the overall knowledge. These results suggest some degree of effectiveness of patient education, either conducted by health professionals or self-driven.

Background Most dietary pattern analyses in southern Europe have relied on a priori food approaches using Mediterranean-style diet indexes. These methods may not reflect the current population's food consumption. Objective To assess the association of a posteriori dietary patterns with acute myocardial infarction (AMI) and cardiovascular risk markers in the general adult population of Porto, Portugal. Design A population-based case-control study was conducted. Information was collected by trained interviewers. Diet was assessed with a validated 82-item food frequency questionnaire. Participants/setting Cases were patients consecutively hospitalized for an incident non-fatal AMI (n=820), and controls were individuals free of previous AMI selected from the hospitals' catchment area (n=2,196). Statistical analyses Dietary patterns, representing mutually exclusive clusters of individuals, were identified by multivariate finite mixture models among controls. Odds ratios (OR) and their 95% confidence intervals (CIs) were obtained from unconditional logistic regression, with adjustment for main confounders. Results In comparison to women with a "healthy" dietary pattern, those with a "low fruit and vegetables" pattern and a "red meat and alcohol" (also characterized by lower intake of dairy products and vegetables) pattern showed a higher risk of AMI (OR 1.85, 95% CI 1.01 to 3.39 and OR 1.91, 95% CI 1.17 to 3.12, respectively). Female controls with the "red meat and alcohol" pattern also had a higher total to high-density lipoprotein cholesterol ratio. In comparison to men with a "healthy" pattern, those with the "red meat and alcohol" pattern, similar to the counterpart found in women, were more likely to experience an AMI (OR 1.98, 95% CI 1.35 to 2.92); male controls with this pattern had higher diastolic and systolic blood pressure, C-reactive protein, and uric acid levels. Conclusions A dietary pattern with lower fruit and vegetable intakes in women, and a pattern characterized by higher consumption of red meat and alcohol (and lower of dairy products and vegetables) in both sexes, were associated with an increased risk of AMI and adverse cardiovascular risk profiles. These findings highlight the importance of sustained recommendations for fruit and vegetable intake and cautious guidance on consumption of alcoholic beverages, which clusters with less healthy dietary patterns of men and women.