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Coastal and marine ecosystems provide valuable ecosystem services (ES) from which humans derive societal goods and benefits (SG&B) after inputting human capital. Their assessment and integration into management plans are crucial to maintain ecosystem productivity and ensure robust and resilient ecosystems. However, regulating and maintenance ecosystem services (RMES) are usually not given focused attention in ecosystem services assessments, despite their importance in supporting the ecological foundations of ecosystems and the provision of other ES. This research used regional to local indicators and spatial analysis to assess the provision of RMES along a coastal-open sea gradient in the northern coast of Portugal, as a tool to define priority areas for ecosystem-based and protected area management. Nine classes of RMES were identified and eleven indicators were used as proxies to assess and evaluate the continuum coast-sea multifunctionality, ES/SG&B bundles and hotspots and coldspots of ES supply. The study showed that 20% of the study area was classified as hotspots of RMES provision, i.e. areas with statistically significant higher values of RMES provision within the management area, and 28% classified as coldspots, i.e. areas with minimal values. The hotspots were mainly distributed along coastal areas and estuaries, with three main marine regions identified. While in general 39% of the areas identified as important for RMES provision were already protected, in the marine region only 30% of the key areas for RMES provision identified in this study are currently protected. The methods used in this work, using locally based and spatially explicit information on RMES provision, are applicable to other areas globally, as they are fundamental in supporting more effective management decisions at spatial scales from local to the wider regions. • Nine classes of RMES were identified using locally sourced, spatially explicit indicators. • RMES provision hotspot locations mainly along coastal areas and estuaries, with three main marine regions identified. • Potential RMES supply decreased from coast to open sea and moving inland, with 5 main bundles identified. • Hotspots of RMES provision represented 20% of the region, with 28% classified as coldspots. • Overall, protected areas included nearly 40% of areas classified as hotspots, although only 30% in marine areas. [ABSTRACT FROM AUTHOR]

• Patient education is an essential component of diabetes care. • DATE-Q is a tool to assess disease-related knowledge of patients with diabetes. • DATE-Q is reliable and valid to use in Brazil. The DiAbeTes Education Questionnaire (DATE-Q) is a self-administered tool developed to evaluate disease-related knowledge and to assess knowledge of five core components of rehabilitation programs: physical exercise, diet, psychosocial well-being, disease self-management, and complications. To translate and cross-culturally adapt into Brazilian Portuguese, and to test the psychometric properties of the DATE-Q for its use in Brazil. The process of translation and cross-cultural adaptation consisted of five steps: translation into Brazilian Portuguese, synthesis of translation, back translation, expert committee, and pilot test of pre-final version. The pre-final version was applied to a sample of 30 patients with diabetes. Psychometric properties (internal consistency, reliability, construct validity, and ceiling and floor effects) of the final version of the Brazilian Portuguese version of the DATE-Q were tested in a sample of 200 adults with diabetes. There was no conceptual divergence between the original and the translated versions. Ten (50%) items of the DATE-Q were culturally adapted. Internal consistency (Cronbach's alpha coefficient = 0.6), reliability (intraclass correlation coefficient = 0.5), and construct validity (correlation between Diabetes Knowledge Scales and DATE-Q total scores: ρ = 0.7; P < 0.001) were confirmed. Ceiling or floor effects were not identified. The highest scoring item was about healthy eating. The average time for completion of the DATE-Q was 5 min and 51 s, and the completion rate was 100% for all items. The Brazilian Portuguese version of the DATE-Q showed adequate psychometric properties, and results suggested that the tool can be used to assess disease-related knowledge in adults with diabetes in Brazil. [ABSTRACT FROM AUTHOR]