Knowledge and attitude towards the gradual reduction of salt in bread – an online survey

Aim: Assess knowledge and attitude towards the gradual reduction of salt in bread and the potential impact on eating habits of children (6-18 years) and their families, as part as a Health Impact Assessment pilot study.N/

Metástases Tardias de Melanoma Maligno Cutâneo Primário Fino

Cutaneous malignant melanoma is the third most common type of skin cancer, and its incidence has been rising. Its mortality rate is considerable, due to an aggressive phenotype and great ability of dissemination, mainly in the first years of follow- -up. Late recurrences, those presenting more than 10 years after diagnosis, are rare. The main prognostic factor of cutaneous malignant melanoma is tumor thickness, which also guides management. Thin tumors often have a good prognosis. We report a case of a 66-year-old woman with a history of excision of a thin primary cutaneous malignant melanoma of the dorsum, presenting 16 years later with an unexpected, rapidly progressing and lethal recurrence.O melanoma maligno cutâneo é o terceiro tipo mais comum de cancro de pele, e a sua incidência tem aumentado. A taxa de mortalidade associada é considerável, devido ao seu fenótipo agressivo e grande capacidade de metastização, principalmente nos primeiros anos de seguimento. As recidivas tardias, mais de 10 anos após o diagnóstico, são raras. O principal fator de prognóstico do melanoma maligno cutâneo é a espessura tumoral, que também determina o tipo de abordagem. Os tumores finos, geralmente, têm bom prognóstico. Reportamos o caso de uma mulher de 66 anos com antecedentes de excisão de um melanoma maligno cutâneo primário fino, localizado no dorso, que se apresentou 16 anos mais tarde com uma inesperada recidiva, rapidamente progressiva e letal

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Impact of physical activity on redox status and nitric oxide bioavailability in nonoverweight and overweight/obese prepubertal children

Nutritional status might contribute to variations induced by physical activity (PA) in redox status biomarkers. We investigated the influence of PA on redox status and nitric oxide (NO) production/metabolism biomarkers in nonoverweight and overweight/obese prepubertal children. We performed a cross-sectional evaluation of 313 children aged 8-9 years (163 nonoverweight, 150 overweight/obese) followed since birth in a cohort study (Generation XXI, Porto, Portugal). Plasma total antioxidant status (P-TAS), plasma and urinary isoprostanes (P-Isop, U-Isop), urinary hydrogen peroxide (U-H2O2), myeloperoxidase (MPO) and plasma and urinary nitrates and nitrites (P-NOx, U-NOx) were assessed, as well as their association with variables of reported PA quantification (categories of PA frequency (>1x/week and ≤1x/week)and continuous PA index (obtained by the sum of points)) in a questionnaire with increasing ranks from sedentary to vigorous activity levels. U-NOx was significantly higher in children who presented higher PA index scores and higher PA frequency. Separately by BMI classes, U-NOx was significantly higher only in nonoverweight children who practiced PA more frequently (p = 0.037). In overweight/obese children, but not in nonoverweight, P-TAS was higher among children with higher PA frequency (p = 0.007). Homeostasis model assessment index (HOMA-IR) was significantly lower in more active overweight/obese children, but no differences were observed in nonoverweight children. In the fully adjusted multivariate linear regression models for P-TAS, in the overweight/obese group, children with higher PA frequency presented higher P-TAS. In the U-NOx models, U-NOx significantly increased with PA index, only in nonoverweight children. Our results provide additional evidence in support of a protective effect of physical activity, in nonoverweight by increasing NO bioavailability and in overweight/obese children by enhancing systemic antioxidant capacity and insulin sensitivity. These results highlight the importance of engaging in regular physical exercise, particularly among overweight/obese children, in which a positive association between oxidant status and cardiometabolic risk markers has been described.This project was supported by FEDER funds from Programa Operacional Factores de Competitividade – COMPETE [FCOMP-01-0124-FEDER-028751], by national funds from the Portuguese Foundation for Science and Technology (FCT), Lisbon, Portugal [PTDC/DTP-PIC/0239/2012] and by Calouste Gulbenkian Foundation. Liane Correia-Costa was supported by FCT [SFRH/SINTD/95898/2013] and Teresa Sousa was supported by FCT and POPH/FSE (EC) [Ciência 2008 and SFRH/BPD/112005]

The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems.

BACKGROUND: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. METHOD: The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. RESULTS: The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. CONCLUSIONS: Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts

Application Of Continuous Positive Airway Pressure In The Delivery Room: A Multicenter Randomized Clinical Trial.

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.47259-6

Unpredictability in seasonal infectious diseases spread

In this work, we study the unpredictability of seasonal infectious diseases considering a SEIRS model with seasonal forcing. To investigate the dynamical behaviour, we compute bifurcation diagrams type hysteresis and their respective Lyapunov exponents. Our results from bifurcations and the largest Lyapunov exponent show bistable dynamics for all the parameters of the model. Choosing the inverse of latent period as control parameter, over 70% of the interval comprises the coexistence of periodic and chaotic attractors, bistable dynamics. Despite the competition between these attractors, the chaotic ones are preferred. The bistability occurs in two wide regions. One of these regions is limited by periodic attractors, while periodic and chaotic attractors bound the other. As the boundary of the second bistable region is composed of periodic and chaotic attractors, it is possible to interpret these critical points as tipping points. In other words, depending on the latent period, a periodic attractor (predictability) can evolve to a chaotic attractor (unpredictability). Therefore, we show that unpredictability is associated with bistable dynamics preferably chaotic, and, furthermore, there is a tipping point associated with unpredictable dynamics

Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis.

BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients. METHODS: QuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level. RESULTS: We found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled. CONCLUSIONS: This is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group

Health Impact Assessment: Uma Ferramenta de Apoio à Adoção de Políticas Saudáveis na Área da Alimentação

Introdução: O Health Impact Assessment (HIA) combina procedimentos e métodos que avaliam potenciais impactes de projetos, programas ou politicas na saúde e a sua distribuição nas populações. Visa informar e melhorar o processo de tomada de decisão baseada na melhor evidência disponível. Devidamente integrado nos processos de planeamento estratégico, o HIA pode contribuir para a implementação de “Políticas Saudáveis”, tal como definido num dos quatro eixos do Plano Nacional de Saúde. É, assim, um instrumento importante para a concretização de uma abordagem integrada da Saúde em todas as políticas. Objetivo: Desenvolver competências técnicas na área do HIA numa perspetiva de learning by doing, através da capacitação de profissionais de saúde e de outros setores.N/