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The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap. To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal. Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal). The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72–6.46), and disability (OR = 2.43; 95% CI: 1.33–4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20–0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24–0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42–5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01–2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10–0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01–3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28–0.90) and mood disorders (OR = 0.16; 95% CI: 0.09–0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29–10.92). This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions. [ABSTRACT FROM AUTHOR]

Background: Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. Methods: Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. Results: An increment of involuntary hospitalizations was associated with male gender [exp( β ^ ) = 1.31; 95%CI 1.06–1.62, p < 0.05], having secondary and higher education [exp( β ^ ) = 1.45; 95%CI 1.05–2.01, p < 0.05, and exp( β ^ ) = 1.89; 95%CI 1.38–2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp( β ^ ) = 2.02; 95%CI 1.59–2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp( β ^ ) = 1.61; 95%CI 1.21–2.16, p < 0.01, and exp( β ^ ) = 1.73; 95%CI 1.31–2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp( β ^ ) = 0.74; 95%CI 0.56–0.99, p < 0.05], having experienced a suicide attempt [exp( β ^ ) = 0.26; 95%CI 0.15–0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp( β ^ ) = 0.65; 95%CI 0.49–0.86, p < 0.01, exp( β ^ ) = 0.67; 95%CI 0.49–0.90, p < 0.01, and exp( β ^ ) = 0.67; 95%CI 0.46–0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. Conclusions: The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations. [ABSTRACT FROM AUTHOR]

Wheat is a dietary staple consumed worldwide strongly responsible for proteins and carbohydrate population intake. However, wheat production and quality will scarcely fulfill forward demands, which are compounded by high-temperature (HT) events as heatwaves, increasingly common in Portugal. Thus, landraces assume crucial importance as potential reservoirs of useful traits for wheat breeding and may be pre-adapted to extreme environmental conditions. This work evaluates four Portuguese landrace yield and grain composition through attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy, particularly protein content, and their responses to HT treatment mimicking a heatwave. Landraces showed distinct yield traits, especially plant height and first spike grain number, and a similar pattern in FTIR spectra, although revealing differences in grain components' proportions. Comparison between spectra band intensity indicates that Ardito has the highest protein-related peaks, contrary to Magueija, which appears to be the landrace with higher lipid content. In plants submitted to 1 week of HT treatment 10 days after anthesis, the first spike grain size and weight were markedly reduced in all landraces. Additionally, it was observed that a general increase in grain protein content in the four landraces, being the increment observed in Ardito and Grécia, is statistically significant. The comparative assessment of control and HT average FTIR spectra denoted also the occurrence of alterations in grain polysaccharide composition. An integrated assessment of the evaluations performed revealed that Ardito and Magueija landraces presented diverse yield-related characteristics and distinct responses to cope with HT. In fact, the former landrace revealed considerable grain yield diminution along with an increase in grain protein proportion after HT, while the latter showed a significant increase in spikes and grain number, with grain quality detriment. These results reinforce the relevance of scrutinizing old genotype diversity seeking for useful characteristics, particularly considering HT impact on grain production and quality. [ABSTRACT FROM AUTHOR]

Background: The 2008 economic recession has been shown to affect populations' mental health due to deterioration of socioeconomic and living conditions. Concurrently, mental health problems may have constituted a vulnerability to wider social inequalities during this period. Aims: To explore perceptions and experiences of primary health care users and professionals regarding the relationship between mental health and socioeconomic position during the economic recession in Portugal. Method: Data were collected in three primary health care centres in Lisbon Metropolitan Area. Focus groups and semi-structured interviews were conducted with users and professionals, respectively. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Results: Two themes were obtained. The first comprised the relationship between changes in socioeconomic conditions (unemployment, precarious work conditions and financial hardship) and poor mental health. The second involved the consequences of experiencing mental health problems during the recession, namely disability, need of sick leave and early retirement. Conclusions: This study provided a comprehensive overview of the bidirectional relationship between socioeconomic conditions and mental health, emphasizing the need to develop policies to address the drivers of poor mental health during times of economic downturn and tackle the barriers faced by people with mental disorders to promote their full social inclusion. [ABSTRACT FROM AUTHOR]

Background: Research suggests that economic recessions might be associated with a higher use of psychotropic drugs, but literature is scarce and contradictory in identifying the most vulnerable groups. This study aims to assess possible changes in the use of psychotropic drugs due to the economic recession in Portugal, by comparing self-reported consumption in 2008/09 and 2015/16. Methods: Data from the World Mental Health Survey Initiative Portugal (2008/09) and the National Mental Health Survey Follow-Up (2015/16) were used (n = 911). McNemar's tests were performed to estimate changes in consumption of any psychotropic drug and of antidepressants, anxiolytics, and hypnotics/sedatives. Multiple Generalised Estimating Equations models with interaction effects were used to estimate the population odds of consuming psychotropic drugs according to year, gender and age. Results: An increase of 6.74% was estimated in the consumption of psychotropic drugs from 2008/09 to 2015/16. Population odds of consuming any psychotropic drugs in 2015/16 were estimated to be 1.5 times higher than in 2008/09 (OR = 1.50;95%CI:1.13–2.01), particularly for hypnotics/sedatives (OR = 1.60;95%CI:1.14–2.25). Women and older individuals presented higher odds of consuming any psychotropic drugs (OR = 2.79;95%CI:2.03–3.84, and OR = 1.80;95%CI:1.28–2.54), after adjusting for year of assessment and education. However, when evaluating the interaction effect of the year with gender and age, men and younger individuals reported higher odds of consuming any psychotropic drugs in 2015/16, when compared to 2008/09 (OR = 1.85;95%CI:1.08–3.17, and OR = 1.95;95%CI:1.32–2.90, respectively). Conclusions: The findings indicate that the period of economic recession was associated with an increased risk of psychotropic drugs use in Portugal. Consumption of psychotropic drugs remained higher among women and older individuals, but the results suggest that the economic crisis had a disproportionate impact on men and younger individuals. This identification of the most vulnerable population groups is useful to design effective and targeted public health interventions aimed at alleviating the effects of economic recessions. [ABSTRACT FROM AUTHOR]

Ria Formosa lagoon is a coastal system in the south of Portugal, characterized by sediments contaminated from urban and industrial pollution emissions. In this study, sediments from two contrasted metal contamination level sites, colonized by Sarcocornia fruticosa were used in an on-site experimentation. The heavy metal removal efficiencies of S. fruticosa with and without bioaugmentation using autochthonous metal resistant isolated yeast (Saccharomyces cerevisiae) were compared. After 15 days of incubation, the total amount of metal concentration (Cd, Pb, Ni, Cr, and Cu) in sediments and plant matter were compared. We found a striking difference between heavily contaminated site and less contaminated site. Metal reductions in heavily contaminated site were generated more by S. fruticosa which was inoculated with S. cerevisiae. In the less contaminated sediments, the higher percentage reductions were achieved with S. fruticosa alone. Our results indicate that despite the phytoremediation potential of S. fruticosa , the addition of S. cerevisiae , increases the plant phytoremediation capacity. [ABSTRACT FROM AUTHOR]

Assessing durum wheat genomic diversity is crucial in a changing environmental particularly in the Mediterranean region where it is largely used to produce pasta. Durum wheat varieties cultivated in Portugal and previously assessed regarding thermotolerance ability were screened for the variability of coding sequences associated with technological traits and repetitive sequences. As expected, reduced variability was observed regarding low molecular weight glutenin subunits (LMW-GS) but a specific LMW-GS allelic form associated with improved pasta-making characteristics was absent in one variety. Contrastingly, molecular markers targeting repetitive elements like microsatellites and retrotransposons – Inter Simple Sequence Repeat (ISSR) and Inter Retrotransposons Amplified Polymorphism (IRAP) – disclosed significant inter and intra-varietal diversity. This high level of polymorphism was revealed by the 20 distinct ISSR/IRAP concatenated profiles observed among the 23 individuals analysed. Interestingly, median joining networks and PCoA analysis grouped individuals of the same variety and clustered varieties accordingly with geographical origin. Globally, this work demonstrates that durum wheat breeding strategies induced selection pressure for some relevant coding sequences while maintaining high levels of genomic variability in non-coding regions enriched in repetitive sequences. [ABSTRACT FROM AUTHOR]

Macroalgae are valuable resources for human consumption in many countries. This work reports for the first time a comparative evaluation of the nutritional properties of five edible macroalgae from the genus Cystoseira, namely C. humilis, C. tamariscifolia, C. nodicaulis, C. compressa and C. baccata. For this purpose, their proximate composition was determined in terms of moisture, ash, and total contents of protein, lipids, carbohydrates and mineral profile. Cystoseira tamariscifolia and C. baccata were the species that in general had the higher ash, protein and lipid contents, while the highest levels of moisture and total carbohydrates were detected in C. nodicaulis and C. compressa. Cystoseira species had also high amounts of minerals, especially of potassium, calcium and iron, and a favorable Na/K ratio. The present study shows that Cystoseira has a balanced nutritional composition, suitable for human consumption, and that its intake can contribute to a healthy and well-balanced diet. [ABSTRACT FROM AUTHOR]

BACKGROUND: The hospital environment has many occupational health risks that predispose healthcare workers to various kinds of work accidents. OBJECTIVE: This study aims to compare different methods for work accidents investigation and to verify their suitability in hospital environment. METHODS: For this purpose, we selected three types of accidents that were related with needle stick, worker fall and inadequate effort/movement during the mobilization of patients. A total of thirty accidents were analysed with six different work accidents investigation methods. RESULTS: The results showed that organizational factors were the group of causes which had the greatest impact in the three types of work accidents. CONCLUSIONS: The methods selected to be compared in this paper are applicable and appropriate for the work accidents investigation in hospitals. However, the Registration, Research and Analysis of Work Accidents method (RIAAT) showed to be an optimal technique to use in this context. [ABSTRACT FROM AUTHOR]

Characterization of water quality from indoor swimming pools, using chorine-based disinfection techniques, was performed during a 6-mo period to study the occurrence, distribution, and concentration factors of trihalomethanes (THM). Several parameters such as levels of water THM, water and air chloroform, water bromodichloromethane (BDCM), water dibromochloromethane (DBCM), water bromoform (BF), free residual chlorine (FrCl), pH, water and air temperature, and permanganate water oxidizability (PWO) were determined in each pool during that period. Chloroform (CFW) was the THM detected at higher concentrations in all pools, followed by BDCM, DBCM, and BF detected at 99, 34, and 6% of the samples, respectively. Water THM concentrations ranged from 10.1 to 155 μg/L, with 6.5% of the samples presenting values above 100 μg/L (parametric value established in Portuguese law DL 306/2007). In this study, air chloroform (CFAir) concentrations ranged from 45 to 373 μg/m3 with 24% of the samples presenting values above 136 μg/m3 (considered high exposure value). Several significant correlations were observed between total THM and other parameters, namely, CFW, CFAir, FrCl, water temperature (TW), and PWO. These correlations indicate that FrCl, TW and PWO are parameters that influence THM formation. The exposure criterion established for water THM enabled the inclusion of 67% of Lisbon pools in the high exposure group, which reinforces the need for an improvement in pool water quality. [ABSTRACT FROM PUBLISHER]

The capability of Halimione portulacoides, Spartina maritima, and Sarcocornia fruticosa (halophytes very commonly found in salt marshes from Mediterranean areas) for enhancing remediation of tributyltin (TBT) from estuarine sediments was investigated, using different experimental conditions. The influence of H. portulacoides on degradation of the butyltin compounds was assessed in two different ways: (1) a 9-month ex situ study carried out in a site of Sado River estuary, center of Portugal, which used polluted sediments collected at other nonvegetated site from the same estuary; and (2) a 12-month laboratorial study, using both plant and sediment collected at a relatively clean site of Cávado River estuary, north of Portugal, the sediment being doped with TBT, DBT, and MBT at the beginning of the experiment. The role of both S. fruticosa and S. maritima on TBT remediation in sediments was evaluated in situ, in salt marshes from Marim channel of Ria Formosa lagoon, south of Portugal, which has large areas colonized by each one of these two plants. For estimation of microbial abundance, total cell counts of sediment samples were enumerated by the DAPI direct count method. Butyltin analyses in sediment were performed using a method previously validated, which consisted of headspace solid-phase micro-extraction combined with gas chromatography-mass spectrometry after in situ ethylation (with tetraethylborate). Sediments colonized both ex situ and at lab by H. portulacoides displayed TBT levels about 30% lower than those for nonvegetated sediments with identical initial composition, after 9–12 months of plant exposure. In addition, H. portulacoides showed to be able of stimulating bacterial growth in the plant rhizosphere, which probably included degraders of TBT. In the in situ study, which compared the levels of TBT, DBT, and MBT in nonvegetated sediment and in sediments colonized by either S. maritima or S. fruticosa from the same area, TBT and DBT were only detected in nonvegetated sediment, whereas MBT was quantified in most samples. This work demonstrated that H. portulacoides has potentiality to be used for enhancing TBT remediation in sediments from salted areas. The results observed in situ for S. maritima or S. fruticosa suggested that these two salt marsh plants also favored TBT remediation. Therefore, the application of halophytes in technologies for TBT remediation in sediments seems to be efficient both in situ and ex situ, cost effective, and nondestructive, despite the fact that they have been rarely used for this purpose so far. [ABSTRACT FROM AUTHOR]

Wheat is one of the most important cereals for food and feed, and it is, therefore, necessary to determine the effects of short-term high temperature events (heatwaves) during grain filling. These heatwave events are increasingly common, especially in Portugal. In this work, seven commercial varieties recommended for production in Portugal were submitted to one-week high temperature (HT) treatment ten days after anthesis to evaluate heat effects on grain yield and quality. Grain yield parameters, such as grain number and weight, were evaluated as well as grain composition through attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. Variation in HT response between varieties was detected. Grain number and weight tended to decrease in most varieties analyzed. However, two varieties proved to be more resilient since grain number and weight remain unaltered in the Bancal variety, which is the one with better yield results, and even increased in the Pata Negra variety. Regarding grain composition, the comparison between ATR-FTIR spectra of milled grains from control and HT plants revealed alterations in peaks assigned to polysaccharides and proteins. Additionally, a model was built based on nitrogen elemental analysis to predict protein content in flour samples through spectral data that corroborated the differences identified by spectra profile comparison. Moreover, both analyses showed that the intervarietal diversity observed in control conditions was significantly reduced in HT treated plants. The results obtained highlight the intervarietal diversity of wheat response to HT, regarding grain yield parameters, grain composition, and particularly, protein content. [ABSTRACT FROM AUTHOR]

Wheat is undoubtedly one of the most important crops worldwide and it is essential to study how the distinct varieties answer to heat waves associated with climatic changes, in order to design adequate wheat breeding strategies. To assess high temperature (HT) impact in wheat grain characteristics, seven commercial varieties, which have been recommended for production in Portugal, were submitted for one-week HT treatment ten days after anthesis. Firstly, predicted grain technological quality was determined by giving high scores for all varieties studied, based on the allelic compositions of genes encoding high molecular weight glutenins, granule-bound starch synthase and puroindolines. The effects of HT on transcription levels of those genes were, for the first time, evaluated in distinct wheat genotypes, in comparison with control plants. Finally, protein fraction content in mature grains were also estimated in untreated and treated plants. Immature grains from plants, maintained in control conditions, showed significant intervarietal differences in transcription levels of genes associated with grain quality traits, a variability that was significantly reduced in grains from HT treated plants. On the other hand, the influence of HT in mature grain protein-fractions and in gliadin/glutenin ratios revealed intervarietal diversity, even with opposite effects in some varieties. The present study, therefore, discloses marked variability in parameters associated with flour quality between the wheat varieties analyzed, which are differentially affected by HT treatments, similar to heat waves frequently observed in climate change scenarios. [ABSTRACT FROM AUTHOR]

Background: Mental disorders are a major cause of disability with impacts on daily functioning and quality of life, which has been associated with socioeconomic disadvantage. The present study aims to assess how socioeconomic position is related to the disability reported by people with mental disorders, using data from the World Mental Health Survey (WMHS) Initiative Portugal. Methods: Using data from the Portuguese Mental Health Survey, a nationally representative cross-sectional study ( n = 3849), several logistic regression models with interaction terms were performed to evaluate the effect of different indicators of socioeconomic position on the disability reported by people with any mental disorder (any 12-month mood or anxiety disorder). Odds ratios were estimated at the specific values of the main effects and interaction terms between the presence of any mental disorder and education, employment status, self-perceived financial deprivation and subjective social status. Results: The prevalence rate of any mood or anxiety disorder was 21.0% ( n = 788), among which 14.7% ( n = 115) reported disability. The results show that among people with any 12-month mental disorder, those in the employment category of "retired or others" had two times higher odds of reporting disability (OR = 2.19; 95%CI: 1.06–4.48) when compared to participants categorized as "working". Likewise, individuals with financial deprivation had two times higher odds of reporting disability when compared to those non-financially deprived (OR = 2.36; 95%CI: 1.31–4.24). The odds ratios obtained for the specific years of education evaluated were not statistically significant but seem to suggest an educational gradient. Conclusions: The findings of this study indicate that the disability reported by people with mental disorders varies according to socioeconomic position and draw attention to the need to develop policies to address these inequalities. [ABSTRACT FROM AUTHOR]

The use of coercive measures in mental health care is an important indicator of the quality of care being provided, and non-patient-related factors are increasingly recognized to contribute to their use. The study aimed to explore the perspectives of mental health care professionals who have first-hand experience with the use of coercion on the contextual factors that influence the use of coercion in the Portuguese mental health care. Five focus group discussions were conducted among 23 doctors and 17 nurses from five psychiatric departments in urban and rural regions of Portugal. Discussions were audio recorded, transcribed, and analyzed with the aid of MAXQDA. Four broad themes related to insufficient resources, staff-related factors, inefficient services, and socio-legal factors were derived. Participants highlighted how inadequate structures, staff shortages, staff attitudes, a lack of training, restrictive ward rules, an inefficient organization of services, the mental health legislation, and public attitudes contributed to the use of coercive measures. The COVID-19 pandemic complicated existing shortfalls in the system and increased the use of coercive measures. The study confirms that the use of coercive measures in mental health care is influenced by factors that are independent of patient characteristics. Addressing existing systemic problems is crucial for the successful implementation of interventions to reduce coercion in mental health care. • Non-patient-related factors contribute to the use of coercion in mental health care. • Low levels of human resources encourage the use of coercive measures. • Inefficiently organized mental health services promote the use of coercive measures. • Ambiguous mental health laws encourage coercion through subjective interpretations. • Policies that address systemic inadequacies can reduce coercion in mental health care. [ABSTRACT FROM AUTHOR]

The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission. [ABSTRACT FROM AUTHOR]

• The most common mental health conditions among female survivors of severe physical intimate partner violence are suicide ideation, PTSD, major depressive episode, and generalised anxiety disorder. • More than one in three female survivors of severe physical intimate partner violence develop PTSD. • Women who had experienced family violence in childhood have greater odds of also experiencing severe physical intimate partner violence. • At least 40 % of female survivors of physical intimate partner violence receive specialised mental health treatment, mostly delivered by a psychiatrist. • Over 60 % address their mental health issues by consulting general physicians or other healthcare professionals. The aim of this article is to study mental health conditions among survivors of severe physical intimate partner violence (IPV) and their utilisation of mental health services. This study is an integrated part of the World Mental Health Survey Initiative-Portugal, for which data was collected from a nationally representative adult sample using well-validated scales. Logistic regression models were used in the analysis. The most common statistically significant mental health conditions among IPV survivors were suicide ideation, PTSD, major depressive episode, and generalised anxiety disorder. More than one in three survivors developed PTSD. Suicide ideation was likely to occur after first experiencing IPV. Almost a half of survivors received specialised mental health treatment; in most cases, delivered by a psychiatrist. Over 60 % addressed their mental health issues consulting general physicians or other healthcare professionals. Those who experienced family violence in childhood had greater odds of also experiencing IPV; survivors of IPV with this experience were more likely to receive mental health treatment. The need to promote greater awareness and competencies of not only mental health professionals but also of general physicians and other healthcare professionals to provide support more effectively to survivors of any type of IPV deserves to be emphasised. [ABSTRACT FROM AUTHOR]

• Exposure to traumatic events is common in Portugal. • Sexual violence had the highest conditional risk of PTSD. • Women were less exposed to traumatic events but had a higher risk of lifetime PTSD. • Sexual violence should be considered a public health priority in Portugal. Although trauma is common worldwide, the relative importance of different types of events in the development of PTSD varies across countries. This study evaluated the exposure to traumatic events, the conditional risk of PTSD, and the sociodemographic factors associated with traumatic events, lifetime and 12-month prevalence of PTSD in Portugal. Data from the World Mental Health Survey Initiative Portugal were used. The worst traumatic event reported by each participant was used to generate estimates of PTSD associated with each event. Conditional risk of PTSD was evaluated in relation to each class and type of traumatic event. Logistic regression models evaluated the association between sociodemographic factors and exposure to traumatic events, lifetime and 12-month PTSD. Most participants were exposed to traumatic events. Sexual violence presented the highest conditional risk of PTSD. Women were less likely to report any lifetime traumatic event. However, after adjusting for type of trauma, women were 2.7 times more likely to experience lifetime PTSD than men. This study may contribute to the design of interventions aiming to reduce the societal burden of PTSD in Portugal, drawing attention to the need to recognize sexual violence and gender inequalities as public health priorities in the country. [ABSTRACT FROM AUTHOR]

In this paper we report the work that jeKnowledge ( Júnior Empresa da Faculdade de Ciências e Tecnologias da Universidade de Coimbra ), a student-led initiative, has done in the ‘ jeKnowledge academy ’ courses to actively engage Portuguese high-school students in STEM education through hands-on projects based on the low-cost Arduino platform. F2F activities, based on a peer-assisted learning strategy, were complemented with tutorials and more advanced project suggestions in a blog. Pre and post surveys on students' attitudes towards programming and peer-coaching were administered to pre-university and first year college participants, finding an overall increase in the Likert scale for all the programming-related constructs under study (confidence, interest, gender, usefulness and professional) after the introductory course. As regards the peer-based learning approach, younger students seemed to be more eager to be taught in a less formal way than their older counterparts. The course resulted in high degrees of satisfaction for both the student tutors and their tutees. [ABSTRACT FROM AUTHOR]

In this paper we report the work that jeKnowledge ( Júnior Empresa da Faculdade de Ciências e Tecnologias da Universidade de Coimbra ), a student-led initiative, has done in the ‘ jeKnowledge academy ’ courses to actively engage Portuguese high-school students in STEM education through hands-on projects based on the low-cost Arduino platform. F2F activities, based on a peer-assisted learning strategy, were complemented with tutorials and more advanced project suggestions in a blog. Pre and post surveys on students' attitudes towards programming and peer-coaching were administered to pre-university and first year college participants, finding an overall increase in the Likert scale for all the programming-related constructs under study (confidence, interest, gender, usefulness and professional) after the introductory course. As regards the peer-based learning approach, younger students seemed to be more eager to be taught in a less formal way than their older counterparts. The course resulted in high degrees of satisfaction for both the student tutors and their tutees. [ABSTRACT FROM AUTHOR]

Objective:  To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT)., Methods:  Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group - 2010-2014; and MDT group - 2015-2021. Descriptive analysis of their characteristics and maternal outcomes., Results:  During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy - one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units., Conclusion:  After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

The influence of suction on the mechanical behaviour of unsaturated chemically stabilised soils is still mostly unknown and unquantified. This is also motivated by the difficulties associated with the experimental procedure required to fully characterise the unsaturated response of the soil, including its direct influence on traditional strength tests. The present paper presents the soil water retention curves obtained for a Portuguese soil before and after being stabilised with Portland cement (OPC) and an alkali-activated cement (AAC). Saturated undrained triaxial tests were also performed for the same curing conditions (0, 28, and 90 days). Previous attempts to characterise the retention curve of soils stabilised with AAC are unknown, and the results showed that the pore volume structure is already formed after 28 days, prior to the full development of the gel matrix responsible for the strength increase between 28 and 90 days. The curve changed after stabilisation, and with each binder, as the OPC presented a higher air-entry value and a narrower suction range compared to the AAC solution. The significant differences between the curves obtained from each binder suggest the future development of a methodology to assess the quality of the AAC stabilisation.

This qualitative study explores solutions proposed by primary health care users and professionals to address the consequences of the economic recession and austerity measures on populations' mental health and delivery of care in Portugal. Qualitative data were collected in three primary health care centres in the Lisbon Metropolitan Area. Five focus groups with 26 users and semistructured interviews with 27 health professionals were conducted. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Solutions proposed by users focused on improvements in accessibility and management of services, socioeconomic and living conditions, human resources for health, and investment in mental health. Health professionals focused on improvements in integration and articulation of services, infrastructure and structural barriers to primary care, recruitment and retention of human resources, and socioeconomic and living conditions. The themes from both groups were integrated and organized into three axes for action: 1) increasing investment and reversing austerity measures in health and social sectors; 2) coordination and integration of mental health care; and 3) tackling the social determinants of mental health. The findings provide an assessment of the needs and priorities set by primary health care users and professionals, reflecting their contextspecific experiences. These complementary perspectives highlight the need for inter-sectoral efforts in policy-making to improve delivery of care and to mitigate social inequalities in health across the Portuguese population., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In the NICU, systematic exposure to sound-pressure above the recommended level can affect both neonates and staff. This study aimed to evaluate the sound pressure levels in three Portuguese NICUs and the noise perceptions of staff. The measurements were performed with a sound-level meter, considering the location of the main sources of noise and the layout of the units. A questionnaire was applied to assess noise perceptions of professionals. Among the staff, 41.1% classified the environment (regarding noise) as "slightly uncomfortable"; 48.4% considered it as "acceptable." The majority (55.5%) considered "equipment" the most annoying source of noise. The results showed that noise levels were excessive in all the evaluated areas of the NICUs, exceeding international guidelines, with levels ranging between 48.7 dBA to 71.7 dBA. Overall, there is a need for more research to verify the effectiveness of some actions and strategies to reduce the effect of noise in the NICU.

Background: Common mental disorders are highly prevalent and disabling, leading to substantial individual and societal costs. This study aims to characterize the association between disability and common mental disorders in Portugal, using epidemiological data from the World Mental Health Survey Initiative., Methods: Twelve-month common mental disorders were assessed with the CIDI 3.0. Disability was evaluated with the modified WMHS WHODAS-II. Logistic regression models were used to assess the association between disability and each disorder or diagnostic category (mood or anxiety disorders)., Results: Among people with a common mental disorder, 14.6% reported disability. The specific diagnoses significantly associated with disability were post-traumatic stress disorder (OR: 6.69; 95% CI: 3.20, 14.01), major depressive disorder (OR: 3.49; 95% CI: 2.13, 5.72), bipolar disorder (OR: 3.41; 95% CI: 1.04, 11.12) and generalized anxiety disorder (OR: 3.14; 95% CI: 1.43, 6.90). Both categories of anxiety and mood disorders were significantly associated with disability (OR: 1.88; 95% CI: 1.23, 2.86 and OR: 3.94; 95% CI: 2.45, 6.34 respectively)., Conclusions: The results of this study add to the current knowledge in this area by assessing the disability associated with common mental disorders using a multi-dimensional instrument, which may contribute to mental health policy efforts in the development of interventions to reduce the burden of disability associated with common mental disorders., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

It is well recognized that professional musicians are at risk of hearing damage due to the exposure to high sound pressure levels during music playing. However, it is important to recognize that the musicians' exposure may start early in the course of their training as students in the classroom and at home. Studies regarding sound exposure of music students and their hearing disorders are scarce and do not take into account important influencing variables. Therefore, this study aimed to describe sound level exposures of music students at different music styles, classes, and according to the instrument played. Further, this investigation attempted to analyze the perceptions of students in relation to exposure to loud music and consequent health risks, as well as to characterize preventive behaviors. The results showed that music students are exposed to high sound levels in the course of their academic activity. This exposure is potentiated by practice outside the school and other external activities. Differences were found between music style, instruments, and classes. Tinnitus, hyperacusis, diplacusis, and sound distortion were reported by the students. However, students were not entirely aware of the health risks related to exposure to high sound pressure levels. These findings reflect the importance of starting intervention in relation to noise risk reduction at an early stage, when musicians are commencing their activity as students.

Studies on microbial characterization of cold-smoked salmon and salmon trout during cold storage were performed on samples available in the Portuguese market. Samples were also classified microbiologically according to guidelines for ready-to-eat (RTE) products. Further investigations on sample variability and microbial abilities to produce tyramine and histamine were also performed. The coefficient of variation for viable counts of different groups of microorganisms of samples collected at retail market point was high in the first 2 wk of storage, mainly in the Enterobacteriaceae group and aerobic plate count (APC), suggesting that microbiological characteristics of samples were different in numbers, even within the same batch from the same producer. This variation seemed to be decreased when storage and temperature were controlled under lab conditions. The numbers of Enterobacteriaceae were influenced by storage temperature, as indicated by low microbial numbers in samples from controlled refrigeration. Lactic acid bacteria (LAB) and Enterobacteriaceae were predominant in commercial products, a significant percentage of which were tyramine and less histamine producers. These results might be influenced by (1) the technological processes in the early stages of production, (2) contamination during the smoking process, and (3) conditions and temperature fluctuations during cold storage at retail market point of sale.

Evidence indicates that exposure to high levels of noise adversely affects human health, and these effects are dependent upon various factors. In hospitals, there are many sources of noise, and high levels exert an impact on patients and staff, increasing both recovery time and stress, respectively. The goal of this pilot study was to develop, implement, and evaluate the effectiveness of a training program (TP) on noise reduction in a neonatal intensive care unit (NICU) by comparing the noise levels before and after the implementation of the program. In total, 79 health professionals participated in the study. The measurements of sound pressure levels took into account the layout of the unit and locations of the main sources of noise. General results indicated that LAeq levels before implementation of the training program were often excessive, ranging from 48.7 ± 2.94 dBA to 71.7 ± 4.74 dBA, exceeding international guidelines. Similarly, following implementation of the training program, noise levels remained unchanged (54.5 ± 0.49 dBA to 63.9 ± 4.37 dBA), despite a decrease in some locations. There was no significant difference before and after the implementation of TP. However, a significant difference was found for Lp,Cpeak, before and after training staff, suggesting greater care by health care professionals performing their tasks. Even recognizing that a TP is quite important to change behaviors, this needs to be considered in a broader context to effectively control noise in the NICU.

Background: Familial amyloid polyneuropathy (FAP) type I is caused by a mutated transthyretin (TTR V30M) and characterized by a sensorimotor and autonomic neuropathy. Renal, cardiac, and ocular abnormalities can also occur. Anemia has been described in previous reports, but its prevalence in Portuguese FAP patients is not precisely known. The aim of this study was to estimate the prevalence of anemia in FAP type I Portuguese patients and to evaluate the contribution of erythropoietin (Epo) to its genesis., Methods: A retrospective cross-sectional study was undertaken to determinate the prevalence and characteristics of anemia in 165 FAP patients. For comparison analysis, 3 control groups were also evaluated, 1 group of 46 apparently healthy subjects, 1 group of 17 asymptomatic carriers of FAP-trait, and a group of 14 non-FAP patients with chronic renal insufficiency. Serum Epo levels were analyzed in all groups., Results: Anemia was present in 24.8% of symptomatic FAP patients. Iron stores, B12 vitamin, and serum folate levels were normal. FAP patients presented significantly lower serum Epo levels than healthy controls (P= 0.003). Epo levels were found lower than expected for the degree of anemia and in 17.5% were undetectable. Low Epo values were observed independently of the presence of renal failure or anemia, and sometimes preceded clinical disease., Conclusion: Anemia in FAP type I is a common manifestation. The results clearly suggest a defective endogenous Epo production in the genesis of the anemia.